Round-trip Travel Time Research Articles

Analisis Kinerja Operasional Light Rail Transit (LRT) Stasiun Demang Kota Palembang

This research examines the operational performance and user satisfaction of the Light Rail Transit (LRT) mass transportation system in Palembang City, particularly on the LRT Demang Lebar Daun station corridor. The study involves the collection of primary and secondary data, including passenger numbers, waiting times, travel intervals, and travel times. The research results indicate that the average number of passengers per LRT station is approximately 10 passengers, resulting in a load factor ranging from 9% to 11%. While passenger comfort levels are relatively high, this low ridership may impact operational efficiency. The waiting times and travel intervals of the LRT are relatively short, enhancing passenger comfort, but warrant operational considerations. Furthermore, the study notes that the round-trip travel time on the LRT is approximately 2 hours, 33 minutes, and 57 seconds. However, limited parking facilities at the Demang Lebar Daun station can affect the interest in using the LRT. In order to improve operational performance and user satisfaction of the LRT, this research recommends an evaluation of travel intervals, waiting times, and daily LRT trip numbers. Additionally, improvements in parking facilities at LRT stations should be considered to enhance the convenience of using this mode of transportation.

Medical Costs and Caregiver Burden of Delivering Disease-Modifying Alzheimer’s Treatments with Different Duration and Route of Administration

BackgroundMultiple disease modifying treatment for Alzheimer’s disease are currently in clinical development or have been recently approved for use. They have vastly different treatment properties but so far, little work has been done to quantify the impact of treatment properties on the treatment’s value in terms of medical and social care costs and caregiver burden.ObjectivesThis study aims to analyze how the mode of treatment administration, treatment frequency and duration, and monitoring requirements affect the value of disease modifying treatments. In order to isolate these effects, we compare five hypothetical disease modifying treatments with equal efficacy and safety: (1) chronic bi-weekly intravenous infusion, (2) chronic four-weekly intravenous infusion, (3) 52 weeks fixed duration four-weekly intravenous infusion, (4) chronic subcutaneous injections, and (5) chronic oral prescription on their direct medical costs, caregiver burden, and preservation of treatment value.DesignSurvey of Alzheimer’s disease treatment clinics and retrospective data analysis.SettingUnited States.MeasurementsDirect medical cost and caregiver burden of treatment administration and monitoring compared to gross treatment benefit.ResultsChronic bi-weekly infusion treatment had the highest direct medical cost ($45,208) and caregiver burden ($6,095), reducing the treatment value by 44%, while oral treatment with the lowest direct medical cost ($1,983) and caregiver burden ($457) reduced the treatment value by only 2%. Substantial caregiver burden was reported from the survey, with a reported average of 2.3 hours for an office visit and infusion, 44 minutes of round-trip travel time, and 78% of patients being accompanied by a caregiver for treatment.ConclusionBurden of chronic intravenous treatments exceed the gross medical and social care cost savings and value of caregiver benefit. The results suggest the need for less complex treatments that require fewer clinic visits to preserve the economic value of disease modifying treatments.

Technical Feasibility of a Hydrail Tram–Train in NA: Okanagan Valley Electric Regional Passenger Rail (OVER PR)

Booming population and tourism have increased congestion, collisions, climate-harming emissions, and transport inequities in The Okanagan Valley, Canada. Surveys suggest that over 30% of residents would shift from cars back to public transit and intercity tram–trains if regional service and connections were improved. Intercity streetcars (aka light-rail tram–trains) have not run in Canada since their replacement in the 1950′s by the national highway system. UBC researchers analyzed a tram–train service fashioned after the current Karlsruhe model but powered by zero-emission hydrogen fuel cell/battery hybrid rail power (hydrail) technology, along a 342 km route between Osoyoos, B.C. at the US Border and Kamloops, B.C., the Canadian VIA rail hub. Hydrail trains have operated successfully since 2018 in Germany and were demonstrated in Quebec, Canada in 2023. However, hydrail combined with tram–train technology has never been tried in Canada. Single-train simulations (STSs) confirmed its technical feasibility, showing a roughly 8 h roundtrip travel time, at an average train velocity of 86 km/h. Each hydrail tram–train consumed 2400 kWh of energy, translating to 144 kg of hydrogen fuel per roundtrip. In total, five tons of H2/day would be consumed over 16 h daily by the 16-tram–train-vehicle fleet. The results provide valuable insights into technical aspects and energy requirements, serving as a foundation for future studies and decision-making processes in developing zero-emission passenger tram–train services not just for Okanagan Valley communities but all of Canada and NA.

Consuming Patients' Days: Time Spent on Ambulatory Appointments by People With Cancer.

In qualitative work, patients report that seemingly short trips to clinic (eg, a supposed 10-minute blood draw) often turn into "all-day affairs." We sought to quantify the time patients with cancer spend attending ambulatory appointments. We conducted a retrospective study of patients scheduled for oncology-related ambulatory care (eg, labs, imaging, procedures, infusions, and clinician visits) at an academic cancer center over 1 week. The primary exposure was the ambulatory service type(s) (eg, clinician visit only, labs and infusion, etc.). We used Real-Time Location System badge data to calculate clinic times and estimated round-trip travel times and parking times. We calculated and summarized clinic and total (clinic + travel + parking) times for ambulatory service types. We included 435 patients. Across all service day type(s), the median (IQR) clinic time was 119 (78-202) minutes. The estimated median (IQR) round-trip driving distance and travel time was 34 (17-49) miles and 50 (36-68) minutes. The median (IQR) parking time was 14 (12-15) minutes. Overall, the median (IQR) total time was 197 (143-287) minutes. The median total times for specific service type(s) included: 99 minutes for lab-only, 144 minutes for clinician visit only, and 278 minutes for labs, clinician visit, and infusion. Patients often spent several hours pursuing ambulatory cancer care on a given day. Accounting for opportunity time costs and the coordination of activities around ambulatory care, these results highlight the substantial time burdens of cancer care, and support the notion that many days with ambulatory health care contact may represent "lost days."

Consuming patients’ days: Time spent on ambulatory visits by persons with cancer.

324 Background: Health care-related time burdens faced by persons with cancer can be substantial. In qualitative work, patients report that ‘’seemingly short clinic visits (e.g., a supposed 10-minute blood draw) often turn into all-day affairs.” We sought to estimate the total time spent (home-to-home) by patients with cancer on ambulatory services at an urban cancer center. Methods: We conducted a retrospective study of all patients with cancer scheduled for any ambulatory care (e.g., laboratory testing, imaging, procedures, infusions, clinician visits) at a Midwestern academic cancer center during a randomly selected week (Monday-Friday) in January 2023. We extracted sociodemographics, clinical characteristics, and services received from the electronic medical record. The primary exposure was the ambulatory care type or combination received by a patient on a day (e.g., clinician visit only, labs and infusion, etc.). Using data from the Real-Time Location System (RTLS) badge that patients wear from clinic entry to exit (standard of care to optimize clinic workflow), we tracked time spent in each patient location (e.g., exam room) and in the clinic overall. We estimated round-trip travel times using home and clinic zip codes and SAS/Google Maps. We calculated median parking time by directly observing 20 random patients between the clinic and their vehicles (e.g., parking ramp or valet). We calculated and summarized clinic and total (clinic + travel + parking) times for different ambulatory care types. Results: We analyzed 468 encounters by 436 unique patients (median age, 64 years, 52% women, 82% white race, 19% breast cancer). Median (IQR) clinic time per encounter was 118 (76-200) minutes. The median (IQR) round-trip driving distance and travel time was 33 (21-53) miles and 50 (36-68) minutes. The median parking time was 8 (6-10) minutes. The median (IQR) total time was 189 (136-277) minutes. Table 1 presents the times by type(s) of ambulatory services. Conclusions: In this single-center retrospective study, pursuing ambulatory cancer care on a given day required patients (and their accompanying care partners) to commit several hours to their care. These findings highlight the need to decrease care time demands on patients to mitigate time toxicity. Accounting for opportunity time costs and the coordination of other daily activities around ambulatory care, these results support our previously proposed practical measure of the time burdens of cancer care—that any day with in-person healthcare contact may represent a ‘’lost day.”[Table: see text]

Fifteen Years of Millimeter Accuracy Lunar Laser Ranging with APOLLO: Data Set Characterization

We present data from the Apache Point Observatory Lunar Laser-ranging Operation (APOLLO) covering the 15 yr span from 2006 April through the end of 2020. APOLLO measures the Earth–Moon separation by recording the round-trip travel time of photons from the Apache Point Observatory to five retro-reflector arrays on the Moon. The APOLLO data set, combined with the 50 yr archive of measurements from other lunar laser ranging (LLR) stations, can be used to probe fundamental physics such as gravity and Lorentz symmetry, as well as properties of the Moon itself. We show that range measurements performed by APOLLO since 2006 have a median nightly accuracy of 1.7 mm, which is significantly better than other LLR stations.

Assessing Patient-Reported Experiences for In-Person and Telemedicine-Based Preoperative Evaluations.

Background: The COVID-19 pandemic has transformed health care delivery through the rise of telehealth solutions. Though telemedicine-based care has been identified as safe and feasible in postoperative care, data on initial surgical consultations in the preoperative setting are lacking. We sought to compare patient characteristics, anticipated downstream care utilization, and patient-reported experiences (PREs) for in-person versus telemedicine-based care conducted for initial consultation encounters at a hernia and abdominal wall center. Methods: Patients evaluated at an abdominal wall reconstruction center from August 2021 to August 2022 were prospectively surveyed. Patient characteristics, anticipated downstream care utilization, and PREs were compared. Results: Of the 176 respondents, 50.6% (n = 89) utilized telemedicine-based care and had similar demographic and disease characteristics to those receiving in-person care. Telemedicine-based care saved a median of 47 min [interquartile range 20-112.5 min] of round-trip travel time per patient, with 10.1% of encounters resulting in supplemental in-person evaluation. A large proportion of telemedicine-based and in-person encounters resulted in recommendations for operative intervention, 38.2% versus 55.2%, respectively. Indirect costs of care were significantly lower for patients utilizing telemedicine-based services. Patient satisfaction related to encounters was non-inferior to in-person care. Overall, the majority of patients responded that they preferred future care to be delivered via telemedicine-based services, if offered. Conclusions: Preoperative telemedicine-based care was associated with significant cost-savings over in-person care related with comparable patient satisfaction. Health systems should continue to dedicate resources to optimizing and expanding perioperative telemedicine capabilities.

The Influence of the Internal Properties of River Ice on Ground Penetrating Radar Propagation

Ground penetrating radar (GPR) has proven to be a very effective method for examining ice thickness. However, two preconditions must be met for this approach to be useful; the round-trip travel time of electromagnetic (EM) waves and radar transmission speed in the ice must be known. These issues are problematic because many factors affect radar transmission speed in ice, including impurities, physical properties such as porosity and density, and temperature. Results show that if these factors are not taken into account and a signal velocity of 0.17 m/ns in pure ice is used to estimate thickness, overestimates will result. We carried out a series of GPR surveys using dual channel host 200 MHz shielded antennas at the Toudaoguai Hydrological Station on the Yellow River, China, and collected samples to analyze ice impurities and physical properties. The results show that the ice crystal types include frazil, granular, and column at the Toudaoguai Hydrologic Station section. Our analysis of ice gas bubble and sediment content showed that the gas bubble volume content is between 11.95 and 13.0% in the frazil ice and between 7.9% and 8.6% in granular and columnar ice. At the same time, the ice sediment content ranged between 0.11‰ and 0.57‰, and the average was 0.24‰ in granular and columnar ice, which was about one-tenth that of the suspended sediment concentration in water. Additionally, a combination of GPR data as well as ice impurities, porosity, density, and temperature enabled us to provide insights on the variability of radar transmission speed and the equivalent dielectric permittivity in river ice. Our extensive observations reveal that radar transmission speed falls between 0.141 m/ns and 0.164 m/ns and that the equivalent dielectric permittivity of river ice increases in concert with ice temperature.

Estimating road traffic impacts of commute mode shifts.

This work considers the sensitivity of commute travel times in US metro areas due to potential changes in commute patterns, for example caused by events such as pandemics. Permanent shifts away from transit and carpooling can add vehicles to congested road networks, increasing travel times. Growth in the number of workers who avoid commuting and work from home instead can offset travel time increases. To estimate these potential impacts, 6-9 years of American Community Survey commute data for 118 metropolitan statistical areas are investigated. For 74 of the metro areas, the average commute travel time is shown to be explainable using only the number of passenger vehicles used for commuting. A universal Bureau of Public Roads model characterizes the sensitivity of each metro area with respect to additional vehicles. The resulting models are then used to determine the change in average travel time for each metro area in scenarios when 25% or 50% of transit and carpool users switch to single occupancy vehicles. Under a 25% mode shift, areas such as San Francisco and New York that are already congested and have high transit ridership may experience round trip travel time increases of 12 minutes (New York) to 20 minutes (San Francisco), costing individual commuters $1065 and $1601 annually in lost time. The travel time increases and corresponding costs can be avoided with an increase in working from home. The main contribution of this work is to provide a model to quantify the potential increase in commute travel times under various behavior changes, that can aid policy making for more efficient commuting.

Environmental Impact of Ambulatory Telehealth Use by a Statewide University Health System During COVID-19.

Objective: Several studies before the COVID-19 pandemic documented the positive impact of telehealth on patients' travel distance, time, out-of-pocket costs, and greenhouse gas emissions. The objective of this study was to calculate these outcomes following the increased use of ambulatory telehealth services within five large University of California (UC) health care systems during the COVID-19 pandemic. Methods: We analyzed retrospective ambulatory telehealth data from the five UC health care systems between March 1, 2020, and February 28, 2022. Travel distances and time saved were calculated using the round-trip distance a patient would have traveled for an in-person visit, while cost savings were calculated using Internal Revenue Services' (IRS) 2022 standard mileage reimbursement rates. In addition, we estimated the injuries and fatalities avoided using the national motor vehicle crash data. Greenhouse gas emissions were estimated using the 2021 national average vehicle emission rates. Results: More than 3 million (n = 3,043,369) ambulatory telehealth encounters were included in the study. The total round-trip distance, travel time, and travel cost saved from these encounters were 53,664,391 miles, 1,788,813 h, and $33,540,244, respectively. These translated to 17.6 miles, 35.3 min, and $11.02 per encounter. By using telehealth, 42.4 crash-related injuries and 0.7 fatalities were avoided. The use of telehealth for ambulatory services during this time eliminated 21465.8 metric tons of carbon dioxide, 14.1 metric tons of total hydrocarbons, 212.3 metric tons of exhaust carbon monoxide, and 9.3 metric tons of exhaust nitrogen oxide emissions. Conclusions: Telehealth use for ambulatory services in a statewide academic Health System during COVID-19 had a positive impact on patient travel distance, time and costs, injuries and fatalities in motor vehicle accidents, and greenhouse gas emissions. These significant advantages of telehealth should be considered when planning future health services.

The Impact of Telemedicine on Indirect Patient Costs in an Outpatient Radiation Oncology Department

Purpose/Objective(s)Patients incur more than medical-related expenses when attending necessary consultation and follow-up visits, including time and travel costs. With the rapid integration of telemedicine in response to the COVID-19 pandemic, our department gained another tool that has the potential to reduce the financial burden of cancer care for our patients. The aim of this study was to estimate the indirect cost savings (time, travel costs, opportunity costs) resulting from the use of telemedicine at a large, academic radiation oncology outpatient clinic located in a densely populated suburban setting. We hypothesize that telemedicine provides time- and cost-savings for patients.Materials/MethodsAll telemedicine and in-person visits scheduled at our main outpatient clinic over a one-week period in June 2021 were retrospectively reviewed. Care visits with patients residing outside of the state were excluded. Travel distance and time calculations were estimated using Google Maps and based on patients’ reported home address. Travel cost was calculated using the IRS 2021 standard mileage rate of $0.56 per mile. Opportunity cost was calculated by multiplying round-trip travel time with estimated hourly wage, derived by median household income per census block group and in the context of a 40-hour work week. Annual projections were calculated by multiplying weekly cost savings by 52.ResultsA total of 156 patients had scheduled visits in our department over one week, 115 of which were via telemedicine. There was no difference in gender, race, ethnicity, and insurance status between telemedicine and in-person visits. Those attending telemedicine vs in-person visits were younger in age (61 vs 68 yrs, p=0.03). There was no significant difference between distance or time traveled to the cancer center between telemedicine and in-person cohorts. For telemedicine visits, median per-visit round-trip travel time saved was 66 minutes (IQR, 39-168 minutes) with a travel cost savings of $33.60 (IQR, $17.92 - $100.80), opportunity cost savings of $67.04 ($42.97 - $118.56), and overall cost savings of $110.57 (IQR, $59.94 - $202.04). Annually, telemedicine visits are estimated to save patients a total travel time of 12911.6 hours, travel costs of $402,684, opportunity costs of $530,588, and overall cost savings of $933,272.ConclusionTelemedicine benefits patients with time- and cost-savings in an outpatient radiation oncology clinic. Our estimates are likely under-representative of the entire financial impact, as costs related to childcare, parking, tolls, hotels, and meals were not captured in our analysis. These unmeasured costs are likely amplified for those patients who live further from the clinic. Despite this, travel distance was not associated with utilization of telemedicine. In clinically appropriate situations, patient-centered metrics such time- and cost-savings should be considered when informing the choice between telemedicine and in-person visits.

Exploration and Prediction of the Elderly Travel Behavior Based on a Novel GR-GA-BP Hybrid Model

With the aging trend in megacities, the travel behaviors of the elderly have attracted much attention. Accurate prediction of the travel behaviors of the elderly is a key link to meet the traffic demand and public facilities’ optimization. The aim of this paper was to explore the link between the travel characteristics and variables of the daily activities of the elderly. Based on a stratified sampling survey, the internal relationship between the characteristics of the elderly and their travel behavior was studied and discussed in this work. A novel grey correlation degree–genetic algorithm–back propagation (GR-GA-BP) hybrid model was proposed to predict the travel behavior of the elderly. Then, a grey correlation degree module was established and used to analyze the correlation between the individual elderly characteristics and their travel behavior. The results showed the following: (1) Both the times of weekly trips (y1) and average round-trip travel time (y2) were highly sensitive to the external environment, especially buses, subway stations, and recreational facilities. The size of the family was less sensitive to the travel behavior. (2) Referring to prediction of the times of weekly trips, the MRE of the proposed model was 23.12%, which was 15.22% less than the baseline models. (3) In terms of the prediction of round-trip travel time, the MRE of the proposed model was 7.13%, which was 14.00–69.41% lower than the baseline models. (4) The times of trips per week were 3.5. In summary, this paper provides technical support for formulating traffic demand policies and facilitates the configuration of cities for an aging society.

Asteroids for μHz gravitational-wave detection

A major challenge for gravitational-wave (GW) detection in the $\ensuremath{\mu}\mathrm{Hz}$ band is engineering a test mass (TM) with sufficiently low acceleration noise. We propose a GW detection concept using asteroids located in the inner Solar System as TMs. Our main purpose is to evaluate the acceleration noise of asteroids in the $\ensuremath{\mu}\mathrm{Hz}$ band. We show that a wide variety of environmental perturbations are small enough to enable an appropriate class of $\ensuremath{\sim}10\text{ }\text{ }\mathrm{km}$-diameter asteroids to be employed as TMs. This would allow a sensitive GW detector in the band $(\mathrm{few})\ifmmode\times\else\texttimes\fi{}{10}^{\ensuremath{-}7}\text{ }\text{ }\mathrm{Hz}\ensuremath{\lesssim}{f}_{\mathrm{GW}}\ensuremath{\lesssim}(\mathrm{few})\ifmmode\times\else\texttimes\fi{}{10}^{\ensuremath{-}5}\text{ }\text{ }\mathrm{Hz}$, reaching strain ${h}_{c}\ensuremath{\sim}{10}^{\ensuremath{-}19}$ around ${f}_{\mathrm{GW}}\ensuremath{\sim}10\text{ }\text{ }\ensuremath{\mu}\mathrm{Hz}$, sufficient to detect a wide variety of sources. To exploit these asteroid TMs, human-engineered base stations could be deployed on multiple asteroids, each equipped with an electromagnetic transmitter/receiver to permit measurement of variations in the distance between them. We discuss a potential conceptual design with two base stations, each with a space-qualified optical atomic clock measuring the round-trip electromagnetic pulse travel time via laser ranging. Trade space exists to optimize multiple aspects of this mission: for example, using a radio-ranging or interferometric link system instead of laser ranging. This motivates future dedicated technical design study. This mission concept holds exceptional promise for accessing this GW frequency band.

Improved Seafloor Geodetic Positioning via Sound Velocity Correction Based on the Precise Round-Trip Acoustic Positioning Model

Seafloor geodetic positioning is crucial for evaluating the marine geodetic network and monitoring various marine activities. We propose a sound velocity correction method based on the precise round-trip acoustic positioning model to improve the accuracy of seafloor geodetic positioning. The proposed method models the sound velocity error related to sound velocity profile (SVP) deviation and time-varying error and reduces the propagation error of the acoustic rays in the ocean. The SVP deviation and seafloor position parameters are resolved simultaneously by the Bayesian estimation using the round-trip acoustic travel time. The time-varying errors of SVP are corrected through symbolic regression using multi-gene genetic programming (MGGP) even without any accurate pre-specified mathematical form of marine environmental variations. The results from sea trial conducted in the South China Sea at a depth of 3000 m demonstrate that the developed method compensates for the sound velocity errors and improves the positioning precision of the seafloor transponder, with the position difference between different data sets better than 46.12 cm, the standard deviation of acoustic time residuals better than 0.15 ms, and the square root of the variance of the position better than 0.41 cm.

Impact of a Medical Clinic Relocation on Travel Time: A Tale of 2 Modes of Transportation.

The aim of this study was to quantify access disparities by examining the impact of a medical clinic relocation on travel time differences for patients using private cars versus public transit. Longitude and latitude of patient home addresses were extracted from electronic medical records for the 4 years before the clinic move. Using offline, open-source, and HIPAA-compliant routing software, roundtrip travel times were computed from each home address to the old and new clinic locations via car and bus. Mean roundtrip travel time by a car changed from 41.3 (IQR 16.1-80.7) to 45.4 (IQR 25.9-78.1) minutes, a 9.9% increase. Mean roundtrip travel time by public transit changed from 67.5 (IQR 51.5-100.2) to 120.8 (100.3-156.1) minutes, a 78.9% increase. Even clinic relocations that minimally impact car travel times can nevertheless yield substantial changes to those traveling by public transit. Clinics and health systems that wish to reduce barriers to accessing health care, especially among those already facing structural inequities, would benefit from utilizing the analytic approach described here.

A Pilot Study Examining Access to and Satisfaction with Maternal Mental Health and Substance Use Disorder Treatment via Telemedicine.

Background: Mental health (MH) and substance use disorders (SUDs) are common during pregnancy and the postpartum year, and have a significant impact on maternal and child health. Most women do not receive treatment for these conditions due to barriers to care. Increasing access to these services via telemedicine is one potential solution to overcoming barriers, but it is unknown if this type of service is acceptable to women. The purpose of this study is to evaluate patient satisfaction with, and accessibility to, a maternal MH and SUD telemedicine service delivered to obstetric practices.Methods: The Telemedicine Satisfaction Questionnaire and the Questionnaire for Assessing Patient Satisfaction with Video Consultation were collected via online surveys. Responses were scored on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). Paired t-tests were used to compare round trip travel time and distance between participants home and specialty clinic at an academic medical center versus their local obstetrics clinic where they received telemedicine services.Results: A total of 91.42% (32/35) of women agreed to take part in the study, and 43.75% (14/32) of women were living in a rural community. Patients reported high levels of satisfaction with the following: overall quality of care (mean [M] 4.66 [standard deviation, SD, 0.67]); similarity to face-to-face are (M 4.69 [SD 0.63]); and access to care (M 4.47 [SD 0.81]). Compared with in-person care at an academic medical center, women receiving care via telemedicine spent significantly less time (67.44 minutes vs. 256.31 minutes, p < 0.001) and distance (50.33 miles vs. 236.06 miles, p < 0.001) traveling round trip.Conclusions: Women receiving MH and SUD treatment via telemedicine within their obstetrician's office report high levels of satisfaction and increased access to care with this modality of treatment delivery. Telemedicine may provide one solution to removing barriers to care and mitigating the maternal and child risks associated with of untreated MH and SUDs.

Male Infertility.

Male Infertility.

In-Person Versus Video Preoperative Visit: A Randomized Clinical Trial

Study Objective To determine if preoperative video visits are non-inferior to in-person visits in preparing women for pelvic reconstructive surgery as measured by a preoperative preparedness questionnaire (PPQ). Secondary objectives included patient satisfaction, convenience, visit duration, total perioperative visits, and patient travel time and distance. Design Non-inferiority randomized controlled trial. Setting Preoperative counseling visit. Patients or Participants Women planning to undergo pelvic reconstructive surgery. Interventions Participants underwent either preoperative in-person versus video counseling. The primary outcome was composite score of the Preoperative Preparedness Questionnaire (PPQ). Postoperatively, the preoperative subsection of the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (SCAHPS) was completed. Six weeks postoperatively, total in-person visits, patient-initiated phone calls, and nurse-initiated phone calls were calculated. Round-trip travel time and distance from home to office were calculated. Sample size calculation was 118 subjects to detect a 9-point difference in PPQ composite scores with 80% power and α=0.05. Measurements and Main Results Between July 2019 and November 2020, 691 women were screened, 118 were randomized with 59 in each group. Demographics were similar between groups. Video visits were non-inferior to in-person visits in PPQ scores (63.0 vs 62.5, 95% CI 0.5 (-0.8, ꝏ) p=0.49). Satisfaction was higher for video visits based on composite SCAHPS scores (30.5±2.1 vs 31.3±1.5, p=0.02). Video visits were more convenient (85.2% vs 100%, p=0.01) and of shorter duration for participants (55.9±18.9 vs 37.7±10.3min vs, p<0.01). The video group had fewer office visits than the in-person group (3.0 [2.0,3.0] vs 2.0 [1.0,2.0], p<0.01) and traveled 66 minutes (p<0.01) and 28 miles (p<0.01) less. There were no differences in patient-initiated calls or nurse-initiated calls between groups (1.0[0.0,2.0] vs 1.0[1.0,3.0], p=0.88, 1.0[1.0,2.0] vs 1.0[1.0,2.0], p=0.50 respectively). Conclusion Video preoperative visits are non-inferior to in-person preoperative visits for preparing women to undergo pelvic reconstructive surgery and increase convenience. To determine if preoperative video visits are non-inferior to in-person visits in preparing women for pelvic reconstructive surgery as measured by a preoperative preparedness questionnaire (PPQ). Secondary objectives included patient satisfaction, convenience, visit duration, total perioperative visits, and patient travel time and distance. Non-inferiority randomized controlled trial. Preoperative counseling visit. Women planning to undergo pelvic reconstructive surgery. Participants underwent either preoperative in-person versus video counseling. The primary outcome was composite score of the Preoperative Preparedness Questionnaire (PPQ). Postoperatively, the preoperative subsection of the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (SCAHPS) was completed. Six weeks postoperatively, total in-person visits, patient-initiated phone calls, and nurse-initiated phone calls were calculated. Round-trip travel time and distance from home to office were calculated. Sample size calculation was 118 subjects to detect a 9-point difference in PPQ composite scores with 80% power and α=0.05. Between July 2019 and November 2020, 691 women were screened, 118 were randomized with 59 in each group. Demographics were similar between groups. Video visits were non-inferior to in-person visits in PPQ scores (63.0 vs 62.5, 95% CI 0.5 (-0.8, ꝏ) p=0.49). Satisfaction was higher for video visits based on composite SCAHPS scores (30.5±2.1 vs 31.3±1.5, p=0.02). Video visits were more convenient (85.2% vs 100%, p=0.01) and of shorter duration for participants (55.9±18.9 vs 37.7±10.3min vs, p<0.01). The video group had fewer office visits than the in-person group (3.0 [2.0,3.0] vs 2.0 [1.0,2.0], p<0.01) and traveled 66 minutes (p<0.01) and 28 miles (p<0.01) less. There were no differences in patient-initiated calls or nurse-initiated calls between groups (1.0[0.0,2.0] vs 1.0[1.0,3.0], p=0.88, 1.0[1.0,2.0] vs 1.0[1.0,2.0], p=0.50 respectively). Video preoperative visits are non-inferior to in-person preoperative visits for preparing women to undergo pelvic reconstructive surgery and increase convenience.

Implementation and Evaluation of a Neurology Telemedicine Initiative at a Major Academic Medical Center.

Introduction: The COVID-19 pandemic forced rapid adoption of telemedicine for care of neurology patients. This study contributes to this literature by describing the structure and implementation of telemedicine-based outpatient neurology clinics at the UCLA Medical Center and estimates patient cost savings, before and after the California COVID-19 "Safer at Home" directive, and patient satisfaction. Methods: This was a retrospective, nonrandomized, case series study of telemedicine-based neurological management in an urban academic medical center from October 2018 to June 2020. We estimated roundtrip travel time, roundtrip travel distance, total savings, and surveyed patient and provider satisfaction with telemedicine care. We supported these findings through evaluation of 7,194 patients by telemedicine and conducted 9,189 video visits for neurological care. Results: The median telemedicine patient avoided a roundtrip driving distance of 33 miles and roundtrip travel time of 75 min. Within sample, median hourly earnings were $27/h. The median patient saved $18 on fuel and parking and $36 of time-based opportunity savings, for total savings of $54 per video visit. Eighty-six percent of patients surveyed were satisfied with their video visit experience. Conclusions: Telemedicine reduced travel time and also reduced costs for neurology patients. Patients and providers both reported high levels of satisfaction with telemedicine.

2D speed of sound mapping using a multilook reflection ultrasound tomography framework

Quantitative ultrasound (QUS) has emerged as a viable tool in diagnosing and staging the onset and progression of various diseases. Within the field of QUS, shear wave elastography (SWE) has emerged as the clinical standard for quantifying and correlating the stiffness of tissue to its underlying pathology. Despite its widespread use, SWE suffers from drawbacks that limit its widespread clinical use; among these are low-frame rates, long settling times, and high sensitivity to operating conditions. Longitudinal speed of sound (SOS) has emerged as a viable alternative to SWE. We propose a framework to obtain 2D sound speed maps using a commercial ultrasound probe. A commercial ultrasound probe is localized in space and used to scan a domain of interest from multiple vantage points; the use of a reflector at the far end of the domain allows us to measure the round trip travel times to and from it. The known locations of the probe and the measured travel times are used to estimate the depth and inclination of the reflector as well as the unknown sound speed map. The use of multiple looks increases the effective aperture of the ultrasound probe and allows for a higher fidelity reconstruction of sound speed maps. We validate the framework using simulated and experimental data and propose a rigorous framework to quantify the uncertainty of the estimated sound speed maps.