Terms Of Hours Research Articles

Analysis of the patients who applied to the covid emergency polyclinic in the Cappadocia region

Aims: To perform a retrospective analysis of patients who applied to the covid emergency department of a pandemic hospital within one year. Methods: Patients who applied to the hospital-wide and covid emergency unit between 01.01.2021 and 31.12.2021 in a pandemic hospital were evaluated retrospectively through hospital electronic data. The time of admission, age range, tomography scan rate, and hospitalization rates were evaluated. In the statistical analysis, descriptive analyzes were performed using the Statistical Package for Social Sciences for Windows 21.0 (SPSS 21.0) program. Results: 0.9% of hospital admissions were made from the covid emergency area. 96.3% of the cases were citizens of the Republic of Türkiye. The female patient admission rate was 52.4%, which was higher than that of males. The highest number of applicants was between the ages of 18-65 (79.5%). While the highest number of applications in terms of months was in September (17.1%), the highest number of applications was between 08.00-16.00 (58.5%) in terms of hours. The tomography rate was 9.1%. 2% of hospitalizations were made to the ward and 0.4% to the intensive care unit. Conclusion: During the epidemic period, the way of patient management and patient’s application rates may vary in hospitals and emergency services. During the epidemic, the number of patients ?uctuates in the process and there may be di?erences in age groups. In all kinds of epidemics, it is thought that the data obtained in the past epidemics can guide the reorganization of hospital emergency services.

Barriers to Transportation in Rural Communities: Perspective of Older Adult Users.

Rural older adults who require transportation assistance face more challenges than their urban counterparts. By focusing on a historically underserved population, this study examined specific barriers from the perspective of older adult users and explored potential policy and technology solutions. A cross-sectional study was conducted throughout rural Wisconsin to identify specific barriers to transportation, uncover personal factors associated with identified barriers, and measure causal relationships between identified barriers and travel satisfaction. A total of 580 older adult respondents from 92% of rural counties across the state provided clear answers regarding specific transportation barriers. Of these, 67.6% identified at least one barrier, but only 12.8% had stopped using transportation due to any identified barriers. Top barriers to accessing transportation included service hours, service areas, trip destinations, getting in/out of service vehicles, service reservations, and operational scheduling. Although specific barriers were associated with different sociodemographics, trip purposes, and frequency of transportation usage, logistic regression findings suggested that concerns about service hours, service areas, and service reservation were the only 3 major determinants driving rural older adults' attitudes toward transportation usage. Rural older adults relying on transportation assistance have demonstrated diverse needs and constraints. Rural transportation could provide better support by extending service availability in terms of hours, areas, and destinations, improving door-to-door accessibility by providing "arm through arm" services, enhancing service responsiveness and reliability via age-friendly technology solutions, and implementing a sliding scale subsidy program that takes income level and trip frequency into account.

Broiler Mobility Assessment via a Semi-Supervised Deep Learning Model and Neo-Deep Sort Algorithm.

Mobility is a vital welfare indicator that may influence broilers' daily activities. Classical broiler mobility assessment methods are laborious and cannot provide timely insights into their conditions. Here, we proposed a semi-supervised Deep Learning (DL) model, YOLOv5 (You Only Look Once version 5), combined with a deep sort algorithm conjoined with our newly proposed algorithm, neo-deep sort, for individual broiler mobility tracking. Initially, 1650 labeled images from five days were employed to train the YOLOv5 model. Through semi-supervised learning (SSL), this narrowly trained model was then used for pseudo-labeling 2160 images, of which 2153 were successfully labeled. Thereafter, the YOLOv5 model was fine-tuned on the newly labeled images. Lastly, the trained YOLOv5 and the neo-deep sort algorithm were applied to detect and track 28 broilers in two pens and categorize them in terms of hourly and daily travel distances and speeds. SSL helped in increasing the YOLOv5 model's mean average precision (mAP) in detecting birds from 81% to 98%. Compared with the manually measured covered distances of broilers, the combined model provided individual broilers' hourly moved distances with a validation accuracy of about 80%. Eventually, individual and flock-level mobilities were quantified while overcoming the occlusion, false, and miss-detection issues.

Assessment of Physical activity Level and Sedentary Behaviour Among Pune City Police Personnel Using Global Physical Activity Questionnaire: A Survey

Background: Policemen being an integral part of the law implementation system have long working hours with huge workloads. They may not be able to save time for regular exercise or eat timely healthy meals which may put them at high risk of developing non-communicable diseases like cardiovascular diseases, diabetes, or lifestyle disorders such as obesity. The purpose of this study was to assess their existing physical activity level and sedentary behaviour using Global Physical Activity Questionnaire version 2.0. Objective: To assess the level of physical activity in police officers during work, travel and leisure-time and also determine the sedentary behaviour in them. Method: A cross-sectional study was conducted on 270 policemen, 168 males and 102 females, from 16 different police station of the Pune city using Global Physical Activity Questionnaire. Along with the analysis of demographic factors, data was analysed to evaluate if the study participants met the criteria for physical activity recommended by WHO. Participants were then divided into different categories depending on their energy expenditure i.e., MET-mins/week. Their sedentary behavior was calculated in terms of hours spent in sitting position. Result: Out of the total study participants, 50.4% were physically active and 49.6% were physically inactive.3.7% study participants were involved in the moderate-intensity physical activity at the workplace; 32.2% study participants were active in travel domain and 54.8%in leisure-time domain.12.2% of study participants were involved in vigorous-intensity physical activity in leisure-time domain only. 134 participants were inactive, 132 were low-active, 4 were moderately-active with not a single participant in highly-active category. The average amount of time spent sitting in the male participants was 6.11 + 3.03 hours whereas in female participants it was 7.50 + 2.62 hours. Conclusion: Even though 50.4% policemen were physically active, most of them were “low- active” and very few were “moderately-active” whereas not a single study participant was found to be “highly-active”. Sedentary behaviour in terms of average amount of time spent sitting was found to be more in female than male participants. Also,51.11% percentage of the study participants belonged to the overweight and obese category. Thus, there is huge scope for improving the physical activity level as well reducing the sedentary behavior in these professionals. KEY WORDS: GPAQ, physical activity, sedentary behavior, police personnel, Pune city.

Streamlining regulatory review in a multicenter platform trial: Opportunity to enhance patient centered care and drive innovation and efficiency.

1572 Background: In addition to being required by the Federal Policy for the Protection of Human Subjects for United States-based institutions that receive federal funding and are engaged in cooperative research projects, the use of a central Institutional Review Board (cIRB) has multiple benefits. Yet more advanced trial designs have unique needs and challenges that may hinder adoption of an efficient cIRB. Platform trials, which require both a master protocol and successive individual protocol amendments for each new agent, are prone to high regulatory burden that can slow trial recruitment, representing a significant workload for study personnel. Specific challenges for platform trials include high burden of new amendments and IRB review schedules staggered across sites, making it challenging to have all sites operating under the same amendment concurrently. Methods: Administrative assessments were collected over the course of the I-SPY2 trial. The primary outcome of interest was time from amendment submission to approval (calculated as the number of days from submission to the local IRB by the site investigators to approval by the local IRB). Quantitative data in terms of hours spent on regulatory tasks pre- and post-cIRB implementation was estimated. Site investigators were asked in December 2022 to complete a brief questionnaire to investigate perceptions on changes to workload and level of comfort using a cIRB. Results: Amendments were activated when 50% of high accruing sites had IRB approval. The number of sites with approval for an amendment to go live was < 25% prior to cIRB adoption, and 83% after. Following transition to the cIRB in February 2021, the mean time from amendment submission to approval decreased from 54.4 to 20.7 days by Jan 2023. Changes to the informed consent were possible once the cIRB was adopted, including: standardizing site-specific IRB language in a section of the consent, so it need not be adjusted with every new agent amendment; standardizing site-specific workflows; shortening consent and making it more patient friendly. The average time that CRCs spent on regulatory work at each site decreased by an average of 160 minutes, but was variable, revealing continued use of local IRB, other committees at some sites. A total of 14 respondents completed the survey; most respondents indicated that keeping up with the amendment approval process was easier post-cIRB and 94% were comfortable relying on a cIRB. The short time for cIRB approval revealed the inefficiency of other processes, including coverage analysis and building of drug order sets. Conclusions: Active engagement of cIRB leadership and IRB working group has enabled regulatory review that now takes less than 30 days. The cIRB is now the standard for the I-SPY family of trials. Other services can also be shared and will continue to drive efficiency and reduce the regulatory burden for sites.

Schuwer, R., Gil-Jaurena, I., Aydin, C. H., Costello, E., Dalsgaard, C., Brown, M., ... & Teixeira, A. (2015). Opportunities and threats of the MOOC movement for higher education: The European perspective. International review of research in open and dist

The MOOC model (Massive Open Online Course, for its acronym in English) has emerged as an innovative alternative for university education, allowing massive access to online courses taught by renowned institutions. This model is characterized by its open, flexible and autonomous nature, which has generated a significant impact on the educational landscape. One of the main advantages of the MOOC is its ability to broaden access to university education. Through online platforms, anyone can enroll in courses taught by professors from world-renowned institutions. This has democratized education by removing geographic and economic barriers that often limit access to traditional education. In addition, the MOOC model offers flexibility in terms of hours and location. Students can learn at their own pace, access course materials anytime, anywhere, and tailor their learning process to their individual needs. This promotes autonomous learning and self-regulation, valuable skills in an ever-evolving educational environment. MOOCs cover a wide range of topics and disciplines, giving students the opportunity to explore various fields of study and gain knowledge in areas of specific interest to them. This encourages the diversity of content and the personalization of learning, since students can choose the courses that best suit their needs and educational goals. However, the MOOC model also presents challenges. The lack of interaction and personalized feedback, due to the large number of participants, can make it difficult to deepen the concepts and resolve specific doubts. Additionally, MOOC course completion rates are often low, raising questions about student engagement and motivation. Despite these challenges, the MOOC as an alternative model for university education has proven to be a valuable tool. It has allowed access to education to people from all over the world, promoting flexibility, diversity of content and autonomous learning. As MOOCs continue to be explored and improved, it is expected that they will continue to play an important role in the educational landscape, providing enriching and transformative learning opportunities.

Endoscopic findings are not different in patients with upper gastrointestinal bleeding with COVID-19

Background and Aims: Coronavirus disease-2019 is an emerging disease of global public health concern. We aimed to evaluate the demographic data, clinical properties, risk factors and endoscopy findings of coronavirus disease-2019 patients with upper gastrointestinal system bleeding. Materials and Method: Patients who underwent endoscopy for upper gastrointestinal bleeding between July 2, 2020 and January 29, 2021 and were diagnosed with severe acute respiratory syndrome coronavirus-2 confirmed by polymerase chain reaction were included in the study. In this retrospective study patients with gastrointestinal bleeding were compared as 1:2 case-control. Coronavirus disease-2019 patients who underwent endoscopy for upper gastrointestinal bleeding and the control group were compared retrospectively in terms of demographic data, comorbid diseases, bleeding symptom, drugs administered, laboratory parameters, time between bleeding symptom and endoscopy, endoscopy findings, gastrointestinal bleeding treatment, and mortality rates. Results: Forty Covid-19 patients (23 males, mean age ± SD, 65.92 ± 12.97) and 80 non-Covid-19 control patients (43 males, mean age ± SD, 66.17 ± 15.61) who underwent endoscopy for upper gastrointestinal bleeding were compared. The most common bleeding symptom was melena in both groups (50% vs 60%). Hospitalization in intensive care unit (47.5% vs 20%, P = 0.004) and need for mechanic ventilation (22.5% vs 5%, p = 0.006), use of corticosteroids were more common in coronavirus disease-2019 group (30% vs. 2.5%, p = 0.000). The need for erythrocyt replacement were not different between the groups [median (min - max) 1.5 (0 - 13) vs 0.5 (0 - 22), p = 0.397]. Use of low molecular weight heparin was statistically more common in coronavirus disease-2019 group (32.5% vs 5%, p=0.00). Time elapsed until the performance of endoscopy in terms of hours was significantly longer in coronavirus disease-2019 group (62.97 ± 84.59 vs. 21.85 ± 33.91, p = 0.006). The most common endoscopic finding was gastroduodenal ulcer in both groups. No significant differences were seen in terms of rebleeeding rates. Mortality rate was statistically higher in coronavirus disease-2019 group (37.5% vs 8.8%, p = 0.000). Conclusions: Until more precise guidelines for the management of gastrointestinal bleeding in COVID-19 patients are developed, a case-by-case decision should be made on whether to perform endoscopy and the timing of the procedure, after multidisciplinary assessments are made in terms of patient status, response to medical therapy, treatment resources, and assessment of risks.

The Dilemma of Social Media Benefits to College Programming Students

Social media has become part and parcel of students’ life in colleges as it occupies most of their free times. Over time, results of programming units have shown a downward trend among college students at Technical University of Mombasa in Kenya. Programming, like Mathematics, requires a lot of practice that is now consumed by social media. This study investigated the impact of Social Media on Grades in terms of hours spent and the time of day Social Media is used. Descriptive statistical research was used to gain understanding of the predictive power Social Media has on the Programming Grades. A total of 142 students pursuing Degree and Diploma courses in Information Technology participated in the study. The students were drawn from Technical University of Mombasa and Kenya Coast National Polytechnic. Over 90% of the students were active Social Media users. The research was conducted in 2018-2019 academic year. Results show that social media use could predict students who scored high grades in both Degree and Diploma courses. Such students controlled their usage of Social Media. They did not use Social Media in the early morning hours up to afternoons when they were engaged in serious studies. These students used Social Media anytime of the day - which means, in between serious study sessions. On the other hand, more average students used Social Media even in the early morning and up to afternoon sessions. Notably, more average Diploma students use Social Media at bedtime than anytime. Further research is recommended with more data using Machine Learning techniques to develop a model that will predict success or failure in Programming units depending on how one uses social media.

The Effect of Job Rotation in a Fixed Wage Setting Model

The study investigates the extent job rotation on the career development of Royal Malaysian Navy officers in a fixed wage setting model. It attempts to fill in the gap in literatures concerning the impact of job rotation in a non-conventional wage setting model. The present study is benefited from an actual data set of Royal Malaysian Navy officers that is obtained from Department of Human Resource, Royal Malaysian Navy in 2017. The data consists of 1,686 officers that are ranked from Lieutenant RMN (ZA18/44) to Captain RMN (ZA24/5)2. The analysis of an Ordinary Least Squares OLS regression showed that job rotation is positively associated with education level, training, and experience. The likelihood of job rotation increases if the nature of job is more flexible in terms of hours of work, skill, and content. Further, there is a significant effect of job rotation on wage. Specifically, a quantile regression indicates that the low rank positions such as Lieutenant and Lieutenant Commander are benefited more from job rotation than a Captain in terms of wage premium. However, the small effect of job rotation in the fixed wage setting environment suggests a need to review the way job rotation is being implemented by Department of Human Resource, Royal Malaysian Navy. In this regard, work experience should be viewed as an important catalyst for enhancing the positive wage impact of job rotation, so much so that it outweighs the role played by educational attainment in the Malaysian navy sector.

What's in a game: Video game visual-spatial demand location exhibits a double dissociation with reading speed

This research sought to clarify the nature of the relationship between video game experience, attention, and reading. Previous studies have suggested playing action video games can improve reading ability in children with dyslexia. Other research has linked video game experience with visual-spatial attention, and visual-spatial attention with reading. We hypothesized that the visual-spatial demands of video games may drive relationships with reading through attentional processing. In this experiment we used a hybrid attention/reading task to explore the relationship between video game visual-spatial demands, reading and attention. We also developed novel visual-spatial demand measures using participants' top five played video games for an individual-specific measure of visual demands. Peripheral visual demands in video games were associated with faster reading times, while central visual demands were associated with slower reading times for both phonetic decoding and lexical reading. In addition, video game experience in terms of hours spent playing video games each week interacted with the cueing effect size in the lexical reading condition, with experienced video game players exhibiting a larger cueing effect than participants with less video game experience. These results suggest that exposure to peripheral visual spatial demands in video games may be related to both lexical and sublexical reading processes in hybrid attentional reading tasks such as ours with skilled adult readers, which has implications not only for models of how ventral and dorsal stream reading and visual-spatial attention are integrated, but also for the development of dyslexia diagnostics and remediation.

“Always at Work”: Canadian Academic Librarian Work During COVID-19

To learn about the experiences of librarians working through COVID-19, we conducted semi-structured interviews with academic librarians from across Canada on issues such as workload, collegiality, and overall satisfaction with their working conditions during the pandemic. Themes emerged around job security, workload changes (both in terms of hours worked and the type of work being done), working from home, relationships with colleagues and administrators (including the perceived speed of the institution’s pandemic response and the state of communication from or with administration), and hopes for the future. This article focuses on the semantic elements of librarian work during COVID-19 uncovered during thematic analysis, including an in-depth discussion of how academic librarians’ workload changed; a second planned article will focus on latent themes on the caring nature of library work. This study connects isolated individual situations with the overall picture of what librarians’ work looked and felt like during the COVID-19 pandemic. For library administrators, we identify the ways in which institutional support helped or hindered librarians in doing their work.

OP99 Participatory Approaches Used In Research And Development Of Medical Devices: A Comparison Of Focus groups, Interviews And Surveys

IntroductionMulti-stakeholder engagement in the development and evaluation of medical devices is crucial for aligning devices with stakeholders’ views, needs, and values. Focus groups, interviews, and surveys are often used to involve stakeholders, but these methods have rarely been compared to analyse their relative merits. Therefore, we systematically compared these three methods in terms of themes, interaction, and feasibility.MethodsThe methods were compared in a case-study on surgery with a new endoscopic device for patients with intracerebral haemorrhage. We asked patients, relatives, healthcare professionals and decision-makers about their perspective on this device, and about their perceived quality of hospital care. We conducted the focus groups and interviews in one explorative and one interactive round. The comparison was made in terms of number and content of themes, who and how participants interact, and in terms of hours that needed to be worked by researchers to apply a method.ResultsWe enrolled 18 participants in the focus groups, 17 in the interviews and 43 in the survey. Focus groups generated 31 and 19 themes, and interviews 58 and 40 themes in the explorative and interactive round. Surveys generated 42 themes. Interviews produced various themes about the device that did not occur in the other methods. In the two rounds of the focus group, 13 and 42 percent of the interactions were directly between participants. In interview round one, 98 percent of the interactions were between the interviewer and participant, whereas 80 percent of the interactions in round two were discussions of other participants’ opinions. In focus groups participants were inclined to emphasise agreement, whereas the interviews generated more in-depth discussions. Interviews took three times as many hours as the focus groups and survey.ConclusionsMethods for multi-stakeholder involvement in device development vary considerably. These methodological differences should be taken into account when selecting a method for engaging stakeholders in the early stages of the lifecycle of a medical device.

Similar rate of return to sports activity between posterior-stabilised and cruciate-retaining primary total knee arthroplasty in young and active patient

PurposeCruciate-retaining and posterior-stabilised implant designs are available for primary total knee arthroplasty. However, whether the implant design is associated with a difference in the level of activity still remains unclear. This clinical trial compared posterior-stabilised and cruciate-retaining implants in sport-related patient-reported outcome measures, range of motion, rate of return to sport, and weekly time dedicated to sport in active adults. It was also hypothesised that in young and active patients both implants lead to a similar rate of return to sport in terms of hours per week, type of sport, and joint mobility.MethodsAll patients were evaluated preoperatively and for a minimum of 36 months follow-up. The University of California Los Angeles activity scores, High-Activity Arthroplasty Score, and Visual Analogue Scale were administered preoperatively and at the last follow-up. The range of motion was investigated at admission and the last follow-up. Data concerning the hours per week dedicated to sports and the type of sport practiced were also collected at admission and at the last follow-up. The Kaplan–Meier Curve was performed to compare implant survivorship.ResultsData from 227 procedures (cruciate-retaining: 109, posterior-stabilised: 118) were prospectively collected. At the last follow-up, no difference was reported in The University of California Los Angeles activity scores (p = 0.6), High-Activity Arthroplasty Score (p = 0.1), Visual Analogue Scale (p = 0.9), flexion (p = 0.7) and extension (p = 0.4). No difference was found in the rate of return (p = 0.1) and weekly hours dedicated to sport (p = 0.3). The Kaplan–Meier curve evidenced no statistically significant difference in implant survivorship (p = 0.6).ConclusionsAt approximately five years of follow-up, no difference was reported between cruciate-retaining and posterior-stabilised implants in active adults in sport-related patient-reported outcomes measures, range of motion, pain, weekly time dedicated to sport, rate of return to sport, and implant survivorship.Level of evidenceLevel II, prospective study.

The impact of COVID-19 on Japanese firms: mobility and resilience via remote work.

Drawing on the original survey of Japanese firms during the COVID-19 pandemic, we estimate the impact of the crisis on firms’ sales, employment and hours worked per employee and roles of work-from-home (WfH) arrangements in mitigating negative effects. We find that the lowered mobility, induced by the state of emergency declared by the government and fear of infection, significantly contracted firms’ activities. On average, a 10% reduction in mobility reduced sales by 2.8% and hours worked by 2.1%, but did not affect employment. This muted employment response is consistent with limited changes in aggregate employment at the extensive margin during COVID-19 in Japan. We find that the adoption of WfH before COVID-19 mitigated the negative impact by 55% in terms of sales and by 35% in terms of hours worked. Adapting to the pandemic by increasing the number of remote work employees also helped firms moderately mitigate the negative impact on sales and work hours and reduce the probability of filing for the short-time work subsidy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10797-022-09749-7.

Moving towards the End of Gender Differences in the Habits of Use and Consumption of Mobile Video Games

The world of video games has become one of the most important entertainment niches for society. In the last decade it has surpassed in turnover audio-visual markets such as cinema and music, driving the development of a new form of communication. The increase in the number of female gamers has highlighted the need to discover differences and similarities between players, both in habits and motivations. We present a study based on a survey procedure for the completion of a questionnaire that aimed to cover the age range of 18 to 30 years of Spanish youngsters and that reached a total of 711 valid responses. The results showed that there were no significant differences in terms of hours spent playing video games between the two genders, although there were motivational differences in the reasons for playing, specifically in terms of competition and challenge. The discussion of the results was carried out by means of a comparative statistical analysis of means to confirm the hypotheses and meet the objectives. Despite the existence of significant differences between genders, these were not as notable as might be expected. When it comes to gaming, as we have detected in our study, there were some consumption habits with differentiated gender patterns; however, in relevant indicators such as hours of consumption, increase in lockdown consumption, and spending, there were no significant differences. The gender gap that existed a few years ago between video gamers is becoming progressively narrower.

Ultrasound applied to nursing in the Emergency Medical Service (EMS): a scoping review

Abstract Background: In recent years, ultrasound has represented a new field of application for nursing. Point of Care UltraSound (POCUS) has been defined as an essential skill in the pre-hospital setting. The primary objective of this scoping review is to describe what are the main ultrasound techniques applied by nurses in the pre-hospital emergency setting. The secondary objective is to identify the different training courses implemented in the various studies selected to learn the necessary ultrasound skills. Methods: We conducted a scoping review. The following databases were consulted: PubMed, Cochrane Library, CINAHL and Google Scholar. For the extraction of useful articles, after identifying the inclusion and exclusion criteria, the PRISMA methodology was used, two authors independently analyzed the identified records, in the event of a conflict a third author intervened. Results: The identified records were initially 815. After the duplicates removal, and screening made by the researcher for inclusion criteria, 6 articles were retrieved for qualitative analysis. The most discussed topic is the recognition of pneumothorax: two studies analyzed a specific educational program on ultrasound for flight nurses, three articles evaluated the us of US to verify the correct insertion of devices, and two explored the skills of nurses in performing ultrasound scans. The first study stated that nurses had 86.4% accuracy, 66.6% sensitivity and 100% specificity in ultrasound using; in the second one, nurses had a sensitivity and specificity of 100% in non-traumatized patients and a sensitivity of 60% and a specificity of 93% in trauma patients. Conclusions: Despite the methodological differences of the selected records, the main ultrasound techniques implemented by nurses in the Emergency Medical Service (EMS) are Focused Assessment with Sonography for Trauma (FAST), Extendend Focused Assessment with Sonography for Trauma (E-FAST), evaluation of pneumothorax and visualization of correct insertion of devices (Endotracheal Tube, Nasogastric Tube). At the level of training in the ultrasound field, on the other hand, a certain heterogeneity is highlighted in the structuring of training courses, both in terms of hours of theory and of controlled practice.

Utilization of an Outpatient Integrated Infusion Suite to Decrease Length of Stay, Increase Revenue, and Improve Patient Experience for Elective Chemotherapy Admissions.

Reduction of chemotherapy start times (CST) and length of stay (LOS) for elective chemotherapy admissions is a priority. The aim of this project was to improve efficiency of patient care while simultaneously increasing revenue by reducing LOS and transitioning high-cost chemotherapy to the outpatient setting. A multidisciplinary quality improvement team proposed building a new outpatient infusion suite in close proximity to the inpatient unit. This suite was then integrated into the flow of elective inpatient chemotherapy admissions and discharges for etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R). Quality measures such as CST, LOS, and revenue were used to evaluate the new infusion suite. In the pilot phase of the study, the average CST improved by approximately 1 hour 45 minutes (P = .0218). The mean LOS was reduced from 4.3 to 4.1 midnights (P = .0214). In terms of hours, LOS was reduced from 105.8 to 95.5 hours (P < .0001). A mean quarterly revenue of $309,410 US dollars was noted during the pilot that had not been previously billed. These improvements were sustained throughout the control phase. Delays in CST and prolonged LOS lead to patient dissatisfaction and increased cost to the health care system. Focus groups and patient feedback are important when designing and implementing new workflows. The creation of an outpatient integrated infusion suite allows medical centers to meet patients' expectations of reducing number of visits while also reducing LOS and capturing new revenue. Adherence to scheduling guidelines further reduces the CST for elective chemotherapy administration.

The development of a hybrid model to forecast paddy water temperature as an alert system for high‐temperature damage

AbstractClimate change has led to increasing global air temperatures. In the field of crop cultivation, long‐term high temperatures (heatwaves) during the rice‐growing season might increase the risk of high‐temperature damage to rice, which might result in reductions to the yield and quality of rice. In this study, a hybrid forecast model consisting of a combined paddy field heat balance model and a meteorological forecast model is proposed for predicting 1‐day‐ahead water temperatures as an alert system for high‐temperature damage to paddy fields, with resolution in terms of hours. The results show close agreement between the measured and predicted water temperatures, and the high‐temperature alert accuracy was 88.5%. Additionally, the climate resilience of paddy fields was investigated by using the rising annual temperatures due to climate change. The observations indicate that while paddy fields are sensitive to the climate, their climate resilience can be improved through artificial measures. Farmers and managers of paddy fields can thus be made aware of the water temperatures of the paddy fields in advance to enable reasonable management of water resources and avoid high‐temperature damages caused by extreme weather conditions.

Acquired brain injury nurse-led clinic: roll out, review and referral

Aim: This paper documents the introduction of a nurse-led outpatient clinic for patients post acquired brain injury (ABI). Nurse-led clinics in primary care settings have been widely acclaimed as a positive step towards improving access to investigations and specialist services, and offering a solution towards limited clinician resources. Method: A retrospective analysis was undertaken to review the ABI nurse-led clinic service over a 12-month period. This analysis reviewed how the clinic has impacted the hospital in terms of hours saved by the neurosurgical consultant clinic by the patient attending the nurse-led clinic. This paper also looks at how the clinic benefits the patient by timely access to the ABI clinical nurse specialist along with referrals and review by community-based rehab services, Headway Ireland and ABI Ireland. Findings: Through the review of the ABI clinic over a 12-month period, 47 hours were saved from the consultant led clinics. It was also found that 30% of patients reviewed in the ABI clinic were now in an appropriate ABI community support service. Conclusion: The audit shows that the ABI nurse-led clinic benefits the patient is terms of timely review and follow-up after traumatic brain injury (TBI). The patient also has early access to specialist TBI follow-on services, which enhances recovery and overall quality of care. The nurse-led clinic also benefits the organisation by reviewing and following up on patients who would have previously have been reviewed at the consultant-led clinics, therefore, reducing waiting times.

Product improvement by cycle time reduction through Lean Methodology (Product Sh-3 as Case Study)

This paper aims to determine and study the effect of applying a lean manufacturing approach on reducing cycle time in producing tube cases of the product Sh-3 missile. Since the tube case is the critical part of the sh-3 missiles set and it represents the bottleneck of a Sh-3 missile, the overall cycle time &amp; increasing productivity is depending on it. Lean manufacturing is used to obtain the best resource utilization in various fields, in military manufacturing case, there are special conditions of operation and manufacturing which need a special deal and solutions, using the same tools of approach. In this article, waste analysis,waste identification, and waste elimination were applied using (PDSA approach, 5s, 8 wastes, PokaYoka, visual management, Kaizen, SMED) tools, the optimum cycle time will be determined after applying this study and will be presented in terms of hours and percentage of the previous situation. Generally, the current situation shows that the tube case of the product sh-3 missile is produced in 51 working days with 8 working days between each product and other. The predicted results of this study giving about 10% reduction in the cycle time of the target product.