Reallocation Of Time Research Articles

Equivalence Curves for Healthy Lifestyle Choices.

Understanding equivalence of time-use trade-offs may inform tailored lifestyle choices. We explored which time reallocations were associated with equivalent changes in children's health outcomes. Participants were from the cross-sectional Child Health CheckPoint Study (N = 1179; 11-12 years; 50% boys) nested within the population-based Longitudinal Study of Australian Children. Outcomes were adiposity (bioelectrical impedance analysis, BMI and waist girth), self-reported health-related quality of life (HRQoL; Pediatric Quality of Life Inventory), and academic achievement (standardized national tests). Participants' 24-hour time use (sleep, sedentary behavior, light physical activity, and moderate-to-vigorous physical activity [MVPA]) from 8-day 24-hour accelerometry was regressed against outcomes by using compositional log-ratio linear regression models. Children with lower adiposity and higher HRQoL had more MVPA (both P ≤ .001) and sleep (P = .001; P < .02), and less sedentary time (both P < .001) and light physical activity (adiposity only; P = .03), each relative to remaining activities. Children with better academic achievement had less light physical activity, relative to remaining activities (P = .003). A 0.1 standardized decrease in adiposity was associated with either 52 minutes more sleep, 56 minutes less sedentary time, 65 minutes less light physical activity, or 17 minutes more MVPA. A 0.1 standardized increase in HRQoL was associated with either 68 minutes more sleep, 54 minutes less sedentary time, or 35 minutes more MVPA. Equivalent differences in outcomes were associated with several time reallocations. On a minute-for-minute basis, MVPA was 2 to 6 times as potent as sleep or sedentary time.

24‐hour movement behaviors and fitness in preschoolers: A compositional and isotemporal reallocation analysis

This study analyzed the associations between the 24-hour movement behaviors composition and fitness in preschoolers and investigated predicted changes in fitness when time in active behaviors is reallocated. This cross-sectional study was carried out with 270 preschoolers (132 boys; 3.97±0.80years-old). Light and moderate-to-vigorous physical activity (LPA and MVPA), and sedentary behavior (SB) were verified using an accelerometer. Sleep time was obtained through interviews with parents. Components of physical fitness (cardiorespiratory fitness-CRF, speed-agility, and lower-body muscular strength) were assessed using the PREFIT Battery. To verify the association between 24-hour movement behaviors and physical fitness, the compositional analysis was used, and for the time reallocation, the compositional isotemporal substitution analysis was used for active behaviors (LPA and MVPA). The daily composition, adjusted for body mass index, sex, and age, was significantly associated with CRF (P=.007; r2 =0.29), speed-agility (P<.001; r2 =0.14), and lower-body muscular strength (P=.01; r2 =0.07). For CRF, the addition of MVPA, at the expense of any other behavior, was associated with significant improvements. For speed-agility and lower-body muscular strength, only reallocations between sleep and LPA yielded significant associations. The variation in CRF, speed-agility, and lower-body muscular strength was associated with the 24hours movement composition, and reallocating 5, 10 or 15minutes of SB or sleep for MVPA was significantly positive for CRF (P<.05). The present findings highlight the relevance of decreasing SB and increasing physical activity practice, particularly at high intensities, to promote a better CRF profile for preschoolers.

Reallocating Time From Sedentary Behavior to Physical Activity in Patients With Peripheral Artery Disease: Analyzing the Effects on Walking Capacity Using Compositional Data Analysis.

To examine the associations between physical activity (PA) and sedentary behavior (SB) with walking capacity and the effects of reallocating time from SB to PA in patients with symptomatic peripheral artery disease (PAD) using compositional data analysis. This cross-sectional study included 178 patients (34% females, mean age = 66 [9]y, body mass index = 27.8 [5.0]kg/m2, and ankle-brachial index = 0.60 [0.18]). Walking capacity was assessed as the total walking distance (TWD) achieved in a 6-minute walk test, while SB, light-intensity PA, and moderate to vigorous-intensity PA (MVPA) were measured by a triaxial accelerometer and conceptualized as a time-use composition. Associations between time reallocation among wake-time behaviors and TWD were determined using compositional isotemporal substitution models. A positive association of MVPA with TWD (relative to remaining behaviors) was found in men (βilr = 66.9, SE = 21.4, P = .003) and women (βilr = 56.5, SE = 19.8; P = .005). Reallocating 30minutes per week from SB to MVPA was associated with higher TWD in men (6.7m; 95% confidence interval, 2.6-10.9m) and women (4.5m; 95% confidence interval, 1.5-7.5m). The findings highlight, using a compositional approach, the beneficial and independent association of MVPA with walking capacity in patients with symptomatic PAD, whereas SB and light-intensity PA were not associated.

Options for Meaningful Engagement in Clinical Research for Busy Frontline Clinicians.

In order for health care innovations to be effective and actionable, they must align with the needs and practice patterns of those delivering care at the bedside. While research has started to incorporate the patient voice, it has yet to fully invest in the expertise of frontline clinicians. Frontline clinicians carry a wealth of clinical knowledge and the lived experience of providing real-world medical care that the research community seeks to improve. We consider options for clinicians as research stakeholders along a continuum of engagement as outlined by the UCSF Clinical and Translational Science Institute from minimal to supportive to participatory. In order to make an effective value proposition to support reallocation of clinician time to research engagement, we advocate evaluating the impact of clinicians as stakeholders at both the process level (e.g., clinician satisfaction, study recruitment rates) and endpoint level (e.g., clinical outcomes). Investing in clinicians as research stakeholders can offer benefits for the individual, health system, and population by increasing the generalizability, adoption, and sustainability of effective interventions.

Replacing school and out-of-school sedentary behaviors with physical activity and its associations with adiposity in children and adolescents: a compositional isotemporal substitution analysis

BackgroundLittle is known on how context-specific sedentary behaviors (SB) affect adiposity. This study aimed to investigate compositional associations between context-specific SB and adiposity and estimate the differences in adiposity associated with replacing school and out-of-school SB with physical activity (PA).MethodsThis study included 336 children and adolescents. Time spent in SB and PA was estimated using multi-day 24-hour raw accelerometer data. SB and PA were specified for school and out-of-school times. Fat mass percentage (FM%) and fat mass index (FMI) were used as adiposity indicators. A compositional isotemporal substitution model was used to estimate differences in adiposity associated with one-to-one reallocations of time from context-specific SB to PA.ResultsParticipants spent approximately two thirds of their school and out-of-school time being sedentary. Relative to the remaining 24-h movement behaviors, significant associations between out-of-school SB and adiposity were found in both boys (βilr1 = 0.63, 95% confidence interval [CI] = 0.03–1.22 for FM%; βilr1 = 0.76, 95% CI = 0.03–1.49 for FMI) and girls (βilr1 = 0.62, 95% CI = 0.25–0.98 for FM%; βilr1 = 0.80, 95% CI = 0.28–1.32 for FMI). Replacing 30 min/day of out-of-school SB with out-of-school light PA decreased FM% by 10.1% (95% CI = 3.3–17.9) and FMI by 14% (95% CI = 2.7–24) in girls. No significant associations were found for school SB.ConclusionsA reduction of out-of-school SB in favor of light PA should be advocated as an appropriate target for interventions and strategies to prevent childhood obesity.

Longitudinal Associations of Midlife Accelerometer Determined Sedentary Behavior and Physical Activity With Cognitive Function: The CARDIA Study.

BackgroundTo determine if accelerometer measured sedentary behavior (SED), light‐intensity physical activity (LPA), and moderate‐to‐vigorous–intensity physical activity (MVPA) in midlife is prospectively associated with cognitive function.Methods and ResultsParticipants were 1970 adults enrolled in the CARDIA (Coronary Artery Risk Development in Young Adults) study who wore an accelerometer in 2005 to 2006 (ages 38–50 years) and had cognitive function assessments completed 5 and/or 10 years later. SED, LPA, and MVPA were measured by an ActiGraph 7164 accelerometer. Cognitive function tests included the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop Test. Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA with repeated measures of the cognitive function standardized scores. In men, statistical reallocation of 30 minutes of LPA with 30 minutes of MVPA resulted in an estimated difference of SD 0.07 (95% CI, 0.01–0.14), SD 0.09 (95% CI, 0.02–0.17), and SD −0.11 (95% CI, −0.19 to −0.04) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating better performance. Associations were similar when reallocating time in SED with MVPA, but results were less robust. Reallocation of time in SED with LPA resulted in an estimated difference of SD −0.05 (95% CI, −0.06 to −0.03), SD −0.03 (95% CI, −0.05 to −0.01), and SD 0.05 (95% CI, 0.03– 0.07) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating worse performance. Associations were largely nonsignificant among women.ConclusionsOur findings support the idea that for men, higher‐intensity activities (MVPA) may be necessary in midlife to observe beneficial associations with cognition.

The Welfare Effects of Time Reallocation: Evidence from Daylight Saving Time

Daylight Saving Time (DST) is currently implemented by more than seventy countries, yet we do not have a clear knowledge of how it affects individuals’ welfare. Using a regression discontinuity design combined with a differences-in-differences approach, we find that the Spring DST causes a significant decline in life satisfaction. By inducing a reallocation of time, the transition into DST deteriorates sleep and increases time stress, which in turn affects physical and emotional health. After performing a simple cost-benefit analysis, we find evidence suggestive that ending DST would exert a positive effect on welfare, namely the wellbeing costs associated with DST exceed its benefits.

Welfare Effects of Time Reallocation: Would Ending Daylight Saving Time Affect Wellbeing?

Daylight Saving Time (DST) is currently implemented by more than seventy countries, yet we do not have a clear knowledge of how it affects individuals' welfare. Using a regression discontinuity design combined with a differences-in-differences approach, we find that the Spring DST causes a significant decline in life satisfaction. By inducing a reallocation of time, the transition into DST deteriorates sleep and increases time stress, which in turn affects physical and emotional health. After performing a simple cost-benefit analysis, we find evidence suggestive that ending DST would exert a positive effect on welfare, namely the wellbeing costs associated with DST exceed its benefits.

Revealing Gender Gap Changes in Home Production and Labor Income in Uruguay

A vast international literature provides evidence of the key role of women in household activities as well as a long-term trend of time reallocation towards a more egalitarian gender division of work. Our objective is to study changes in gender gaps in home production and the labor market in Uruguay between 2006 and 2013. Our main conclusions are: i) the gender gaps for time spent in the labor market and home production decreased; ii) women increased time allocated to labor market and slightly reducedtime in home production whereas the opposite is observed for men; iii) both women and men increased time allocated to childcare which results in a stable gender gap; iv) both women and men decreasedtime spent in other household activities, narrowing the gender gap; v) this less unequaldivision of time is also captured when gender gaps are measured in monetary terms, although movement in home production prices did not contribute to reduced gender gaps.

Are Reallocations between Sedentary Behaviour and Physical Activity Associated with Better Sleep in Adults Aged 55+ Years? An Isotemporal Substitution Analysis.

Physical activity has been proposed as an effective alternative treatment option for the increasing occurrence of sleep problems in older adults. Although higher physical activity levels are associated with better sleep, the association between specific physical activity intensities and sedentary behaviour (SB) with sleep remains unclear. This study examines the associations of statistically modelled time reallocations between sedentary time and different physical activity intensities with sleep outcomes using isotemporal substitution analysis. Device-measured physical activity data and both objective and subjective sleep data were collected from 439 adults aged 55+ years. Replacing 30 min of SB with moderate to vigorous intensity physical activity (MVPA) was significantly associated with an increased number of awakenings. Moreover, a reallocation of 30 min between light physical activity (LPA) and MVPA was significantly associated with increased sleep efficiency. Furthermore, reallocating 30 min of SB to LPA showed a significant association with decreased sleep efficiency. There were no significant associations of time reallocations for wake time after sleep onset, length of awakenings, and sleep quality. These results improve our understanding of the interrelationships between different intensities of movement behaviours and several aspects of sleep in older adults.

Prospective study on sedentary behaviour patterns and changes in body composition parameters in older women: A compositional and isotemporal substitution analysis

The aims of this study were to examine the prospective compositional associations between sedentary behaviour (SB) patterns and longitudinal changes in body composition parameters, and to use compositional isotemporal substitution modelling to analyse the longitudinal changes in body composition parameters associated with time reallocation from SB to physical activity (PA) in older women. The study included women aged 60 years and older (n=182) with valid data at baseline and at the subsequent 7-year follow-up. For both time points, the ActiGraph GT1M accelerometer was used for SB and PA assessments and multi-frequency bioimpedance analysis was used to assess the body composition parameters related to adiposity and muscle mass. Compositional regression models were used to analyse the associations between proportion of time spent in sedentary bouts of different duration and longitudinal changes in body composition parameters. A compositional isotemporal substitution model was created to estimate the differences in body composition parameters associated with one-to-one time reallocations between baseline SB and PA. A significant increase in fat mass index (βilr1=0.61, 95% confidence interval [CI]: 0.18, 1.04) and visceral adipose tissue (βilr1=6.01, 95% CI: 1.52, 10.5) was associated with a higher baseline proportion of time spent in long sedentary bouts (i.e. sedentary bout of ≥30min). Reallocating 1h/week and 3.5h/week from the time spent in long sedentary bouts in favour of light PA was associated with a significant decrease in fat mass index by 0.78% (95% CI: 0.24, 1.32) and 3.13% (95% CI: 0.97, 5.29), respectively. No association was found for indicators of muscle mass. This study suggests that long-term adiposity status could be improved by increasing the proportion of time spent in light PA at the expense of time spent in prolonged SB. This finding may help in designing more effective and feasible interventions for the maintenance of healthy body composition in advanced age.

The ethics of care and academic motherhood amid COVID-19.

The COVID‐19 pandemic has upended the lives of working parents as they strive to meet the conflicting demands of childcare and professional obligations. While growing evidence suggests the extraordinary challenges to time and work brought by the pandemic, this article explores the pandemic as an opportunity for stillness and reflection, a personal and professional recalibration. Through a personal narrative describing my experiences as an academic and mother before and during the pandemic, framed within the ethics of care, this article brings light to the untenable reality of working mothers pre‐pandemic, explores the ways in which the pandemic has positively facilitated caring relationships at home as well as the reallocation of time and household responsibilities, and argues for policy and legislative action at the institutional and societal levels that support and value the care work of women and men alike.

Cross-Sectional Associations of 24-Hour Sedentary Time, Physical Activity, and Sleep Duration Compositions with Sleep Quality and Habits in Preschoolers.

Although some studies indicate physical activity and sleep quality are positively associated in children, most reports examined physical activity independent of other 24-h behaviors and focused on older children. The aim of this cross-sectional study was to examine the predicted changes in sleep efficiency and habits when reallocating time between movement behaviors using compositional isotemporal substitution in preschool-aged children. Accelerometers were worn by 288 participants (51.6 ± 9.5 months) for up to 16 days. Sleep outcomes included sleep efficiency, nap frequency, sleep disturbances, and bedtime resistance. Compositional isotemporal substitution analyses demonstrated that the combined effect of 24-h movement behaviors was associated with sleep efficiency (p < 0.001) and nap frequency (p < 0.003). When sleep increased by 30 min at the expense of stationary time or light physical activity, estimates of sleep efficiency and bedtime resistance decreased while nap frequency increased. When stationary time increased by 30 min from moderate to vigorous physical activity, estimated sleep efficiency increased and sleep disturbances decreased. Although this study presents preliminary evidence that 24-h movement behavior compositions in early childhood are associated with sleep quality and nap frequency, estimated effects from theoretical time reallocations across sleep outcomes were mixed.

Pharmacist value-added to neuro-oncology subspecialty clinics: A pilot study uncovers opportunities for best practices and optimal time utilization.

To evaluate neuro-oncology clinician time utilization for medication management and identify a cost beneficial role for integration of a dedicated pharmacy specialists. A pharmacist was temporarily integrated into a neuro-oncology clinic for a 30-day period to evaluate the clinical practice and perform a 14-day clinical chart evaluation and patient interactions as part of a single institutional exploratory analysis. The pharmacist completed screenings for drug-drug interactions, new therapies, medication reconciliation, and advanced interventions as part of a collaborative practice agreement for pharmacist autonomy. Pharmacist time spent was calculated and documented within the patient encounters to support physician decision-making. A comparative estimate of pharmacist versus physician time utilization and cost for each was completed to derive a savings analysis for integration of a dedicated clinic pharmacist. During the 14-day clinical assessment, the pharmacist completed 147 encounters with 338 interventions. Of the encounters, 90% (n = 132) were higher complexity requiring plan modification, and approximately 48% (n = 162) of all interventions required ≥10 minutes of the pharmacist's time. Physician non-patient-facing time devoted to medication tasks was 5-hours weekly (0.125 FTE, full time equivalents), an estimated direct salary cost of $937/week ($45,000 yearly). Hire of a part-time pharmacist at 0.50 FTE would cover the clinical need with supported documentation and medication monitoring at a cost of $45,000/year. Defining the roles for dedicated neuro-oncology clinic pharmacists allows for cost-savings through re-allocation of physician time and improves subspecialty clinic operations as well as patient care.

24-hour movement behaviour and executive function in preschoolers: A compositional and isotemporal reallocation analysis

Adherence to healthy behaviours promotes several health benefits in preschool children, including executive function (EF). Recently, the predictive power of the 24-hour movement behaviour (24 h MB) composition on health outcomes has been evidenced; however, its relationship with EF in preschoolers is unknown. Thus, the present study had two objectives: (1) to analyse the associations between the 24 h MB composition and EF of preschoolers; and (2) to investigate the theoretical changes in EF when time in different movement behaviours is reallocated. This cross-sectional study was carried out with 123 preschoolers (3–5 years old) of low socioeconomic status. Physical activity (PA) and sedentary behaviour were assessed using an accelerometer for 7 days, sleep time was obtained through interviews with parents, and EF was measured using the Early Tool Box battery. To verify the association between 24 h MB and EF, compositional data analysis was used, and for time reallocation, compositional isotemporal substitution analysis was utilized. It was observed that the 24 h MB composition was positively associated with EF (p < .0001; R² = 0.34), and that reallocating 5, 10, 15 or 20 min of the time spent on sleep and light PA to moderate-to-vigorous PA, respectively, was associated with significant improvements in EF (p < .05). These findings provide hitherto unseen insight into the relationship between 24 h MB and EF in preschool children, and warrants consideration for researchers and practitioners seeking to improve EF and PA in preschool children.

Compositional Associations of Sleep and Activities within the 24-h Cycle with Cardiometabolic Health Markers in Adults.

This study aimed to examine how compositions of 24-h time use and time reallocations between movement behaviors are associated with cardiometabolic health in a population-based sample of middle-age Finnish adults. Participants were 3443 adults 46 yr of age from the Northern Finland Birth Cohort 1966 study. Participants wore a hip-worn accelerometer for 14 d from which time spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were determined. These data were combined with self-reported sleep to obtain the 24-h time-use composition. Cardiometabolic outcomes included adiposity markers, blood lipid levels, and markers of glucose control and insulin sensitivity. Multivariable-adjusted regression analysis, using a compositional data analysis approach based on isometric log-ratio transformation, was used to examine associations between movement behaviors with cardiometabolic outcomes. More daily time in MVPA and LPA, relative to other movement behaviors, was consistently favorably associated with all cardiometabolic outcomes. For example, relative to time spent in other behaviors, 30 min·d-1 more MVPA and LPA were both associated with lower 2-h post-glucose load insulin level (-11.8% and -2.7%, respectively). Relative to other movement behaviors, more daily time in SB was adversely associated with adiposity measures, lipid levels, and markers of insulin sensitivity, and more daily time asleep was adversely associated with adiposity measures, blood lipid, fasting plasma glucose, and 2-h insulin. For example, 60 min·d-1 more SB and sleep relative to the remaining behaviors were both associated with higher 2-h insulin (3.5% and 5.7%, respectively). Altering daily movement behavior compositions to incorporate more MVPA at the expense of any other movement behavior, or more LPA at the expense of SB or sleep, could help to improve cardiometabolic health in midadulthood.

Associations of Activity and Sleep With Quality of Life: A Compositional Data Analysis

Associations between time spent on physical activity, sedentary behavior, and sleep and quality of life are usually studied without considering that their combined time is fixed. This study investigates the reallocation of time spent on physical activity, sedentary behavior, and sleep during the 24-hour day and their associations with quality of life. Data from the 2011-2016 Rotterdam Study were used to perform this cross-sectional analysis among 1,934 participants aged 51-94 years. Time spent in activity levels (sedentary, light-intensity physical activity, moderate-to-vigorous physical activity, and sleep) were objectively measured with a wrist-worn accelerometer combined with a sleep diary. Quality of life was measured using the EuroQoL 5D-3L questionnaire. The compositional isotemporal substitution method was used in 2018 to examine the association between the distribution of time spent in different activity behaviors and quality of life. Reallocation of 30 minutes from sedentary behavior, light-intensity physical activity, or sleep to moderate-to-vigorous physical activity was associated with a higher quality of life, whereas reallocation from moderate-to-vigorous physical activity to sedentary behavior, light-intensity physical activity, or sleep was associated with lower quality of life. To illustrate this, a reallocation of 30 minutes from sedentary behavior to moderate-to-vigorous physical activity was associated with a 3% (95% CI=2, 4) higher quality of life score. By contrast, a reallocation of 30 minutes from moderate-to-vigorous physical activity to sedentary behavior was associated with a 4% (95% CI=2, 6) lower quality of life score. Moderate-to-vigorous physical activity is important with regard to the quality of life of middle-aged and elderly individuals. The benefits of preventing less time spent in moderate-to-vigorous physical activity were greater than the benefits of more time spent in moderate-to-vigorous physical activity. These results could shift the attention to interventions focused on preventing reductions in moderate-to-vigorous physical activity levels. Further longitudinal studies are needed to confirm these findings and explore causality.

Can we walk away from cardiovascular disease risk or do we have to \u2018huff and puff\u2019? A cross-sectional compositional accelerometer data analysis among adults and older adults in the Copenhagen City Heart Study

BackgroundIt is unclear whether walking can decrease cardiovascular disease (CVD) risk or if high intensity physical activity (HIPA) is needed, and whether the association is modified by age. We investigated how sedentary behaviour, walking, and HIPA, were associated with systolic blood pressure (SBP), waist circumference (WC), and low-density lipoprotein cholesterol (LDL-C) among adults and older adults in a general population sample using compositional data analysis. Specifically, the measure of association was quantified by reallocating time between sedentary behaviour and 1) walking, and 2) HIPA.MethodsCross-sectional data from the fifth examination of the Copenhagen City Heart Study was used. Using the software Acti4, we estimated daily time spent in physical behaviours from accelerometer data worn 24 h/day for 7 days (i.e., right frontal thigh and iliac crest; median wear time: 6 days, 23.8 h/day). SBP, WC, and LDL-C were measured during a physical examination. Inclusion criteria were ≥ 5 days with ≥16 h of accelerometer recordings per day, and no use of antihypertensives, diuretics or cholesterol lowering medicine. The 24-h physical behaviour composition consisted of sedentary behaviour, standing, moving, walking, HIPA (i.e., sum of climbing stairs, running, cycling, and rowing), and time in bed. We used fitted values from linear regression models to predict the difference in outcome given the investigated time reallocations relative to the group-specific mean composition.ResultsAmong 1053 eligible participants, we found an interaction between the physical behaviour composition and age. Age-stratified analyses (i.e., </≥65 years; 773 adults, 280 older adults) indicated that less sedentary behaviour and more walking was associated with lower SBP among older adults only. For less sedentary behaviour and more HIPA, the results i) indicated an association with a lower SBP irrespective of age, ii) showed an association with a smaller WC among adults, and iii) showed an association with a lower LDL-C in both age groups.ConclusionsLess sedentary behaviour and more walking seems to be associated with lower CVD risk among older adults, while HIPA types are associated with lower risk among adults. Therefore, to reduce CVD risk, the modifying effect of age should be considered in future physical activity-promoting initiatives.

Twenty-four-hour movement behaviours and fundamental movement skills in preschool children: A compositional and isotemporal substitution analysis

ABSTRACT Studies that have analysed the association between the different movement behaviours and fundamental movement skills (FMS) have considered it in an independent manner, disregarding the compositional nature of 24-h movement behaviours (24-h MB). The aim of this study was to investigate the relationship between the 24-h MB and FMS in preschoolers using a compositional data analysis . Two hundred and four preschoolers (4.5 ± 0.8 years old; 101 boys) provided objectively assessed physical activity (PA) and sedentary behaviour (SB) data (Actigraph wGT3X), and FMS (TGMD-2). Sleep duration (SD) was reported by parents. Association of daily composition of movement behaviours with FMS was explored using compositional analysis and isotemporal substitution (R Core Team, 3.6.1). When considered as a 24-h MB composition (PA, SB and SD), adjusted for age, BMI and sex, the composition predicted locomotor (r2 = 0.31), object control (r2 = 0.19), and total motor score (r2 = 0.35), respectively (all P < 0.001). Reallocation of time from light to moderate-to-vigorous PA was associated with greatest positive changes in total motor score. Achieving adequate balance between movement behaviours over the 24-h period, and its relationship with locomotor and object control skills should be considered and further investigated in early childhood.

A Dedicated Orthopaedic Trauma Room Increases Operating Room Throughput without Increasing After-Hours Minutes

BackgroundThe scheduling and execution of both elective and urgent orthopaedic cases prove challenging for many hospital systems. In this study, we examine the operational and cost efficiency of creating a dedicated orthopaedic trauma (DOTOR) block using operating room management data as a surrogate for financial analyses and decision-making. MethodsUsing WiseOR® (Palo Alto, CA), we extracted the total number of cases, after-hours minutes, opportunity-unused time, and in-block time for the orthopaedic trauma service (OTS) and the dedicated orthopaedic trauma room for the nine months prior to our reallocation of block time (December 2015 – August 2016) and the twenty months after this change (October 2016 – May 2018). Unused elective time was either released to the OR or used to accommodate additional trauma cases. We defined after-hours minutes as the time utilized after 1730 Monday through Friday; opportunity-unused minutes as the time within a block allocation in which a service could have adequately performed another case; and in-block as the time in which a service actively used a block allocation. For each month, we analyzed the data for the orthopaedic traumatologists individually (A, B, C) and for the OTS collectively. Before- and after-implementation data were compared using a two-tailed Student t-test (α=0.05). We calculated the total length of after-hours minutes, in-block time, and caseload for each month spanning from December 2015 to May 2018.1 Pareto optimality was graphically represented using GraphPad Prism (v7.01 La Jolla, CA). ResultsOf 1485 orthopaedic procedures analyzed, 382 occurred before the implementation of the dedicated orthopaedic trauma room, and 1103 cases were performed after the implementation. There was a significant increase in total case volume per month for the surgeons (A & B) who were assigned the additional blocks (32.2 vs 45.4 cases per month, p = 0.0001). There was no significant difference in the total case volume performed by the surgeon (C) whose operating schedule had not changed (10.2 vs. 9.8 cases per month, p = 0.804). There was no significant difference in after-hours minutes per month by the two affected orthopaedic traumatologists (A&B) (1030 min vs. 1180 min, p = 0.452) or by the unaffected traumatologist (C) (8.3 min vs. 16.5 min, p = 0.455). There was no significant difference in opportunity-unused minutes after establishing a DOTOR (2542 min. vs. 2895 min., p = 0.4212). Pareto efficiency for OTS opportunity unused time and after hours minutes per block qualitatively improved (Figure 1). Pareto cost efficiency for after hours minutes qualitatively improved (Figure 2). There was no significant difference in monthly associated after-hours costs ($41,752 vs. $51,722, p = 0.2510). ConclusionsIn this study, we demonstrate that a shift towards the DOTOR system can increase OR efficiency by increasing OR throughput without increasing after-hours minutes. This tactical allocation permitted the orthopaedic traumatologists to meet an increasing need for orthopaedic trauma procedures, both semi-elective and urgent, from a growing health network. Furthermore, with the increase in OR availability, the orthopaedic traumatologists were able to offload a small percentage of cases from our general orthopaedic surgeons, shifting add-on cases performed after-hours to scheduled cases performed by a more efficient team.