Time Demands Research Articles

Facilitators’ perspective towards implementation of Competency Based Medical Education (CBME) in a Government Medical College in Delhi: a cross-sectional study

IntroductionCompetency-Based Medical Education has emerged as a transformative approach to medical education worldwide. It focuses on the overall development of trainee physicians to ensure effective and safe patient care.ObjectivesTo evaluate faculty members’ perspectives on Competency-Based Medical Education and identify perceived challenges for its implementation in a medical college in Delhi.MethodsA cross-sectional study was conducted in July 2022 among 127 faculty members of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Data were collected using a validated self-developed questionnaire (Cronbach's alpha: 0.85).ResultsThe median age of the faculty members was 42 years, with a median teaching experience of 10 years. Ninety-one percent of faculty members were aware of Competency-Based Medical Education, and 88% believed it to be superior to the previous curriculum. Integrated teaching (62%) and early clinical exposure (55%) were identified as the most anticipated benefits. Faculty members cited infrastructural deficits (93%) and competing time demands and priorities (85%) as major barriers to implementation.ConclusionTo address the challenges, the National Medical Commission should ensure the availability of sufficient infrastructure and provide regular training programs for faculty members.

European tourism demand in the face of climate change: asymmetric impacts, demand reallocation, and deseasonalisation strategies

Abstract The European tourism industry, a significant contributor to employment and income, is under threat due to climate change. This study, using data from 1315 European regions and considering a tourism-specific climate index and tourism typologies, examines the potential impact of climate change on tourism demand across the continent under four warming scenarios. We find that climate change impacts in Europe will be highly asymmetrical across regions and seasons, resulting in significant reallocations of tourism demand in space and time across all warming scenarios. A clear north-south pattern in tourism demand changes emerges, with northern regions benefiting and southern regions experiencing significant reductions, particularly under higher warming. Summer demand and coastal areas, where tourism demand is more concentrated, will be particularly affected. We also quantify the deseasonalising efforts necessary to maintain the status quo in the annual demand for tourism, involving relative reductions in summer demand and increases in shoulder and winter seasons.

The current state and future direction of childcare for cancer patients: a narrative review.

One in four patients diagnosed with cancer are parents to dependent children. For these patients, childcare services are needed to overcome the time demands of cancer treatment. Despite the childcare support needs and its potential impact on treatment outcomes, targeted childcare services for cancer patients remain limited. This review highlights the state of childcare services and strategies to address the current chasm in childcare for parents diagnosed with cancer. A comprehensive search of PubMed, Google Scholar, and Embase was conducted and 77 studies in the English Language on Childcare services for parents with cancer published between January 1990 and May 2024 were identified and reviewed. The burden of cancer diagnosis and cancer treatment imposes physical, psychological, financial, and time constraints on cancer patients with young dependents. Many cancer patients with children miss treatment appointments and encounter treatment delays due to challenges with childcare. Limited access to childcare is further exacerbated by the financial and time toxicities of cancer and unconventional treatment needs such as emergency department visits, fatigue, and other complications of cancer treatment. So far, only one cancer-center-linked childcare program exists in the U.S., highlighting the scale of unmet need for childcare support in cancer patients. and relevance. Providing non-traditional childcare services, home-based or hospital-based childcare structures, and financial assistance through medical institutions, professional organizations, insurance payers, and government-funded programs could bridge the current gap in childcare needs for parents with a cancer diagnosis.

P-330. Beneath the PPE: Perspectives on Infection Prevention from Emergency Department Healthcare Personnel

Abstract Background Adhering to best practices in infection prevention and control (IPC) can be challenging in emergency departments (EDs) due to high patient volumes, high acuity of illness, and limited initial information about patients’ history, among other factors. Understanding ED healthcare personnel’s (HCP) perceptions is important for improving IPC practices in this environment.Table 1.Demographics of interviewees. Methods Between August 2023 and November 2023, we conducted semi-structured interviews focused on IPC with HCP working in emergency departments across the United States. EDs were selected for inclusion via convenience sampling from a larger group of EDs selected for representative geographic, volume, and practice type variety. Our study solicited voluntary participation from staff in these EDs via their ED leaders. Each interview was recorded, transcribed, and subsequently coded across 19 themes by two independent raters. Each theme as sorted as either a facilitator or barrier to following recommended IPC practices in the ED. We then used content analysis to quantify the frequency of the identified themes, and stratified responses by role group.Table 2.All identified codes and frequencies in interviews. Codes identified in all interviews, sorted into promoters and barriers. Higher percentage is indicative of more mentions of each code across all interviews. Note: IPC = infection prevention and control; HH = hand hygiene; PPE = personal protective equipment. Results We conducted 25 interviews across four role groups (Table 1). Key barriers identified in the interviews included constraints related to time (25/25, 100%), attention (23/25, 92%), environment of care (23/25, 92%), and personal perceptions (23/25, 92%), while top promoters included IPC culture (24/25, 96%) and interpersonal dynamics (23/25, 92%) (Table 2). Stratified analyses indicated that there were variations among roles, with environmental staff emphasizing the importance of training, and nurses highlighting policies both as a promoter and barrier (Table 3).Table 3.Top codes stratified by role. Higher percentage is indicative of more mentions of each code across each group. Codes are stratified by healthcare personnel’s role (with transport and environmental services staff pooled to support staff) and promoter/barrier categorization. Note: IPC = infection prevention and control. Conclusion The main barriers to effective IPC measures perceived by ED staff are limited time and other demands on their attention in the ED environment. A strong culture promoting IPC and cohesive team dynamics were the primary IPC facilitators, suggesting potential targets for future interventions. Future research should explore interpersonal relationships further by conducting comparative studies across different types of hospital emergency departments, and longitudinally while testing strategies to improve IPC adherence. Disclosures All Authors: No reported disclosures

Identifying stakeholder perspectives and priorities for athlete monitoring technology: A mixed-methods study based on interviewing Belgian high-performance sports organisations

The rapid growth of technology in managing training processes offers both opportunities and challenges for sports practitioners. This study examines factors influencing technology adoption in four high-performance sports: golf, sprint kayak, freestyle snowboarding, and volleyball. Each discipline reflects distinct physiological and training needs. Using an interview-based approach and including 25 stakeholders (6 athletes, 14 coaches, and 5 high-performance managers), we captured qualitative and quantitative insights into the perceived benefits and challenges of technology in athlete monitoring. The thematic analysis identified key advantages of technology in athlete monitoring, including objective data support, enhanced engagement, real-time feedback, and increased confidence, while also highlighting concerns around misuse, time demands, and technological complexity. Conflicting views on motivation, comfort, and human oversight further emphasized the challenges in integrating technology effectively. To quantify these insights, we applied the Analytic Hierarchy Process (AHP), a structured prioritisation approach that is new within sports science, to rank essential technology features. Findings ranked Reliability (1st; 18.73%) and Validity (2nd; 18.42%) as top priorities, with Interpretability (3rd; 9.95%), Responsiveness (4th; 9.02%), and Complexity (5th; 8.08%) also valued. Key training priorities included monitoring Technique (1st; 15.94%), Performance (2nd; 15.24%), and Benchmarking (3rd; 11.90%). The thematic analysis highlights the importance of balanced use of technology. In a complementary approach, the AHP provides a structured method for assessing stakeholder priorities, enhancing decision-making and helping align technology development with practitioner needs. By introducing a framework that bridges communication between engineers, scientists, and practitioners, this study guides the development of user-centred sports technologies that effectively address real-world challenges in high-performance organisations.

Capacity management of forwarder with multiple carriers under uncertain flight travel time and stochastic shipment demand

AbstractConsider a freight forwarder who obtains cargo space from multiple carriers. Some capacities are reserved long term in advance through allotment contracts, while some are booked on short‐term daily basis. A unified mathematical program for both short‐ and long‐term problems under uncertainties is proposed. Demands are modeled using a probability distribution as in the stochastic program, whereas flight travel times belong to an uncertainty set as in robust optimization. In the first stage, the allotments are determined. In the second stage, the shipment demand materializes but the travel time is still unknown, the forwarder determines the daily allocation among flights, given the first‐stage allotment. The objective is to minimize the expected total cost in the two stages. We derive a closed‐form solution for a special case, propose a heuristic for a general case, and evaluate its performance via numerical experiments, whose historical records came from one of the largest Thai forwarders.

Assessing Concordance in Post-operative Knee Implant Position Analysis Between Automated Image Analysis Algorithm and Human Radiologists

Aim The authors have developed an automated algorithm-based technique to identify implant position based on post-operative CT scans for total knee arthroplasty. To analyse the performance of this algorithm we compared the implant orientation against two trained radiologists. This was an exploratory secondary analysis from CT scans collected as part of an RCT. Methods To assess this algorithm we used Bayesian hierarchical modeling, which has the unique benefits of being able to accept the null hypothesis and allow interpretation of concordance between the radiologists and our algorithm. Results Results show this automated algorithm is effective for deriving post-operative implant locations from CT scans. Lack of concordance in certain parameters are likely driven by the challenges associated with locating certain implant landmarks due to the geometry of the components. Such limitations will not impact the accuracy of our automated algorithm. With the increase in 3D pre-surgical planning and robotic assistance, these techniques can be used in future studies, such as assessing implant alignment philosophies. Conclusion Overall, this automated algorithmic approach for locating post-operative implant position provides good accuracy, valuable insights in surgical execution and saves resources by reducing the time demands on trained medical specialists.

The Efficiency of Temperature-Controlled Inventory Management: A Case Study of Convenience Store in Salaya Sub-District, Nakhon Pathom Province

Background and Aims: Current logistics management is an important goal that entrepreneurs can use as a source of competitive advantage. Both at the business level and national level. This is because of globalization that has resulted in more intense business competition. And greater trade liberalization As a result, the business sector must upgrade its ability to conduct business in every possible way. The purposes of this research were 1) to investigate the efficiency of temperature-controlled inventory management by studying personal factors, namely work experience, number of employees, position, and monthly average income. And study to investigate the factors of the inventory management system that affect the efficiency of temperature-controlled inventory management in convenience stores. Methodology: The questionnaire was used as a research instrument, it was collected from 15 samples. and collected the direct interviews with managers and employees who administer the inventory control. The statistics that were used were percentage, mean, and standard deviation. The statistics that were used to test the hypothesis were One-Way ANOVA. Results: The result of this study showed that among the sample of 15 convenience store staff, it was found that most of the staff had 1-5 years of work experience, with employees between 11-20 people in general positions, and an average personal monthly income of 10,001-20,000 baht. The hypothesis testing results revealed that the significance of the variables, work experience, position, and average monthly income was greater than the 0.05 level of significance. This indicated that despite differences in work experience, position, and average monthly income, there was no difference in the efficiency of temperature-controlled inventory management for the convenience store in Salaya, Nakhon Pathom. The results of the regression coefficient test revealed that there is only one independent variable had a significant impact on the efficiency of temperature-controlled inventory management of convenience stores. It was the replenishment system. The forecast coefficient was 40.8%. The remaining 59.2% is another factor apart from those mentioned above. For the replenishment system, according to the research results, entrepreneurs should pay great attention to product replenishment and always keep up with the needs of customers to be able to have enough customer service inventory. Conclusion: Work experience, position, and average monthly income do not affect the efficiency of temperature-controlled inventory management of convenience stores in the Salaya Subdistrict. The product replenishment system has an important effect on this efficiency at 40.8 percent. Product replenishment is a factor that entrepreneurs should give importance to to have sufficient inventory and meet customer demand in time.

A Rescheduling Strategy for Multipurpose Batch Processes with Processing Time Variation and Demand Uncertainty

In this paper, we address the problem of dynamic scheduling of a multipurpose batch process subject to two types of disturbances, namely, processing time variation and demand uncertainty. We propose a rescheduling strategy that combines several ideas. First, when we generate a new schedule, we simultaneously construct a Directed Acyclic Graph (DAG) to represent this new schedule. While each node in the DAG represents an operation, each arc represents the dependency of an operation on another. Based on this DAG, we then use a simple procedure to determine how long an operation is allowed to be delayed without affecting the current makespan. After that, when the new schedule is used for online execution, we trigger a rescheduling procedure only when (1) we infer from the predetermined delayable time information that the current makespan will be extended, or (2) we observe new demands, or (3) the current schedule is not guaranteed to be feasible. In the rescheduling procedure, only the affected operations are allowed to be revised, while those unaffected operations are fixed. By doing this, we can reduce system nervousness and improve computational efficiency. The computational results demonstrate that our method can achieve an order of magnitude of reduction in both the number of operation changes and the computational time with a slightly better long-term makespan, compared to the widely used periodically–completely rescheduling strategy.

Evaluation of the effect of the water-energy nexus on the performance of the water-energy supply system.

In this study, the water-energy nexus is investigated throughout coupling the Water Evaluation and Planning (WEAP) and Low Emission Analysis Platform (LEAP) models under the climate change effects in the Marun basin, Iran. For this purpose, first, the climate change effects on water resources and consumption nodes are calculated under representative concentration pathway (RCP) scenarios from the fifth report of the International Panel on Climate Change (IPCC). Artificial neural network (ANN) is used to model river inflow and Cropwat model is used for agricultural water demand in future time (2015-2040). In the next step, water system is modeled in WEAP and energy system is modeled in LEAP. Then, three water-energy nexus scenarios include (1) calculating the actual hydropower generation capacity in LEAP model (W-E-N1), (2) water-energy nexus evaluation indexes in the WEAP model (W-E-N2), and (3) changes in the electricity consumption intensity in the LEAP model (W-E-N3) are modeled under RCP 2.6, RCP 4.5 and RCP 8.5 climate scenarios. The results of W-E-N1 scenario show that the actual hydropower generation capacity with water-energy nexus is reduced by 78%, 89%, and 91%, respectively, compared to no water-energy nexus under RCP 2.6, RCP 4.5, and RCP 8.5 scenarios. The results of W-E-N2 show that the hydropower generation reliability index will be reduced by 19%, 31%, and 13%, respectively under RCP 2.6, RCP 4.5, and RCP 8.5 compared no water-energy nexus. The results of W-E-N3 scenario show that the electricity consumption intensity will increase considering the electricity required for water transferring to demand sites. The results of the present study show that the water-energy nexus will lead to more accurate results and, as a result, more realistic planning for water and energy resources.

Review of Emerging and Nonconventional Analytical Techniques for Per- and Polyfluoroalkyl Substances (PFAS): Application for Risk Assessment

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants that pose significant risks to ecosystems and human health. Increasing regulatory demands for PFAS management have increased the need for rapid and deployable analytical technologies for both abiotic and biotic matrices. Traditional detection methods, such as standardized chromatography, often require weeks to months for analysis due to a limited number of appropriately accredited laboratories, delaying critical decision-making. This literature review is intended to identify promising emerging PFAS analytical techniques or technologies to facilitate more rapid (near real-time) analysis and explore their relevancy in supporting human and ecological risk assessments. Recently developed optical and electrochemical sensing approaches are enabling the detection of PFASs within minutes to hours, with detection limits typically aligning within reported ambient concentrations in water, soil, and sediment. These emerging technologies could (1) support planning and prioritization of sampling efforts during the problem formulation phase of risk assessment, (2) complement traditional chromatography methods to lower time and resource demands to improve sampling frequency over space and time, and (3) aid in risk-informed characterization of PFAS exposures based on identified chemical classes or groups. This review highlights those approaches and technologies that could potentially enhance the comprehensiveness and efficiency of PFAS risk assessment across diverse environmental settings in the future.

Improved feature reduction framework for sign language recognition using autoencoders and adaptive Grey Wolf Optimization

Automatic Sign Language Recognition Systems (ASLR) offers smooth communication between hearing-impaired and normal-hearing individuals, enhancing educational opportunities for impaired. However, it struggles with “curse of dimensionality” due to excessive features resulting in prolonged training time and exhaustive computational demand. This paper proposes technique that integrates machine learning and swarm intelligence to effectively address this issue. The proposed technique, initially, extracts features using histrogram of gradient (HOG) approach and then reduces dimensions of extracted features using unsupervised autoencoder and subsequently refining the feature set with an improved GWO algorithm. A handcrafted artificial neural network serves as the classifier within this integrated framework, denoted as AEGWO-Net. Exhaustive experimentations were conducted on six different datasets namely ASL, ASL MNIST, ISL, ArSL, MNIST Digits, and IEEE-ISL containing gestures of different languages to demonstrate the performance of AEGWO-Net. The AEGWO-Net demonstrates superior performance improving accuracy and F1 score by 6% and 4% respectively compared to PCA-IGWO and KPCA-IGWO algorithms. Achieving high accuracy (98.40%), F1-score (96.59%), MCC (97.14%), and AUC (96.21%) indicates the robustness and generalizability of the AEGWO-Net method even with reduced dimensionality. Furthermore, a comparison between AEGWO-Net with other existing swarm intelligence techniques is also made to demonstrate its superiority.

GAMBARAN PERSEPSI BEBAN KERJA PERAWAT DI INSTALASI GAWAT DARURAT RUMAH SAKIT WILAYAH SLEMAN

Background : Nurses in the Emergency Department (ED) have a higher workload compared to nurses in other units due to the increase in patient numbers, insufficient nursing staff, complex cases, time demands, and limited facilities. Therefore, regular workload assessments are crucial to optimize performance and healthcare service quality. Objective : This study aimed to understand the perception of nurse workload in the ED of hospitals in the Sleman region. Method : This research was a descriptive analytical study with a cross-sectional approach involving 122 nurses in the ED of Sleman Regional Hospital. The study measured nurses' workload perception using Nursalam's (2017) nurse workload questionnaire, covering job activities, types of tasks, and time usage. Univariate analysis was used to describe respondents' characteristics and nurses' workload perception in four EDs in the Sleman region, including RSUP Dr. Sardjito, RSA UGM, RSUD Sleman, and RS PKU Muhammadiyah Gamping. Result : The research findings indicated that the average perception of nurse workload in the ED of Sleman Regional Hospital was 30,8 (SD±9,2), interpreted as a moderate workload. Job activities emerged as the highest domain with an average of 11,3 (SD±3,7) and the statement item with the highest average was direct nurse-patient contact in the ED at 2,7 (SD±1). Conclusion : The overall perception of nurse workload in the ED of Sleman Regional Hospital indicated a moderate workload. The results of this research could serve as a basis for the hospital's ED in formulating policies related to nurse workload.

Clinical Whole-Body Gait Characterization Using a Single RGB-D Sensor.

Instrumented gait analysis is widely used in clinical settings for the early detection of neurological disorders, monitoring disease progression, and evaluating fall risk. However, the gold-standard marker-based 3D motion analysis is limited by high time and personnel demands. Advances in computer vision now enable markerless whole-body tracking with high accuracy. Here, we present vGait, a comprehensive 3D gait assessment method using a single RGB-D sensor and state-of-the-art pose-tracking algorithms. vGait was validated in healthy participants during frontal- and sagittal-perspective walking. Performance was comparable across perspectives, with vGait achieving high accuracy in detecting initial and final foot contacts (F1 scores > 95%) and reliably quantifying spatiotemporal gait parameters (e.g., stride time, stride length) and whole-body coordination metrics (e.g., arm swing and knee angle ROM) at different levels of granularity (mean, step-to-step variability, side asymmetry). The flexibility, accuracy, and minimal resource requirements of vGait make it a valuable tool for clinical and non-clinical applications, including outpatient clinics, medical practices, nursing homes, and community settings. By enabling efficient and scalable gait assessment, vGait has the potential to enhance diagnostic and therapeutic workflows and improve access to clinical mobility monitoring.

Modeling and the Use of Surrogate Endpoints: Is This a Valid Approach?

Development of novel colorectal cancer (CRC) screening tests is a dynamic field. Decision analytic modeling based on inputs derived from rigorous prospective studies informs CRC screening guidelines. Exploratory modeling may have a place in early phases of test development. We explored whether (1) surrogate endpoints for long-term, programmatic effectiveness, and cost-effectiveness could be potentially informative in early stages of test development and (2) whether rapid exploratory modeling with a web-based tool would be feasible. First, based on comparisons with published estimates for reductions in CRC mortality with various screening tests in four established decision analytic models of CRC screening, the surrogate endpoint of the number needed to colonoscope to detect one CRC or advanced precancerous lesion (APL) in round 1 of screening appears to hold promise as a measure of clinical effectiveness. Similarly, based on comparisons with published estimates for cost/quality-adjusted life-year gained with screening in the four models, the surrogate endpoint of cost to detect one CRC or APL in round 1 of screening appears to hold promise as a measure of cost-effectiveness. Second, exploration of the impact of lowering the screening initiation age in Israel from age 50 to 45 with the web-based EU-TOPIA tool, compared with the results of a recently published comprehensive modeling study, suggests that exploratory modeling of programmatic screening may be feasible with relatively low time demand vs. that required for typical full-length modeling publications. Further validation in other models and with a broader set of test performance characteristics is prudent before surrogate endpoints or rapid modeling are incorporated into the novel test development process.

A multi-period inventory model with price, time and service level dependent demand under preservation technology investment

A multi-period inventory model with price, time and service level dependent demand under preservation technology investment

A multi-period inventory model with price, time and service level dependent demand under preservation technology investment

A multi-period inventory model with price, time and service level dependent demand under preservation technology investment

Towards sporadic demand stock management based on simulation with single reorder point estimation

The goal of this paper is to decide whether bootstrapping and/or linear regression are suitable to estimate an initial reorder point in sporadic demand stock management based on past stock movement simulation (PSMS) in combination with neighborhood search-oriented optimization. Thus, we randomly generate demand data including 20–80% zero demand periods and simulate continuous review, fixed order quantity inventory control policy (R, Q) for 4 different arrangements of PSMS combined with local search (LS) with a number of bootstrapping sampling runs ranging from 5 to 500. The original idea of LS is to underestimate order lead time demand using linear regression (LR), overestimate lead time demand with the help of bootstrapping (B) and search the generated interval using PSMS to return R, Q with the optimal trade-off between inventory costs and service level. The outputs gained from simulation experiments show that avoiding the generation of overestimated reorder point with B seems to be a more sensible choice as the consumption of computational time is significantly higher than in case of LR. On the other hand, using an LR based initial reorder point may require the exploration of neighborhood in both directions, while B rather enables a more efficient one-way search as it suffers from significantly less blindness caused by PSMS compensating underestimated order lead time demand with increased replenishment orders. Furthermore, estimating just one initial reorder point brings a better opportunity to control the consumption of computational time through assigning a certain amount of computational time to every change of the initial reorder point, as a time to evaluate a single R, Q combination via PSMS is relatively stable.

Pohled ergoterapeutů, fyzioterapeutů a pacientů na aplikaci tradičních a inovativních postupů Constraint-induced movement therapy v České republice

Background: The comprehensive therapeutic program, Constraint-induced movement therapy (CIMT), focuses on functional training of the paretic upper limb and the transfer of acquired skills in daily life. Aim: The purpose of the survey was to map the current experience of therapists and patients with the therapeutic toolkit and home activity monitoring. Methods: The components of CIMT currently used, monitoring forms, barriers to provision, and motivations and subjectively perceived limitations for the use of technology in rehabilitation for activity monitoring were explored with the use of on-line surveys. Results: A total of 95 occupational therapists and physiotherapists and 91 patients participated in the survey. Czech therapists reported the most common perceived barriers that limit CIMT provision were as follows: low number of suitable patients, lack of knowledge of the method, increased administrative and time demands, or concerns about the high demands of the method for patients. The patients themselves are then limited in participating in the program due to its low accessibility or fear of the high difficulty of the exercise. As part of monitoring, patients complete a paper exercise diary (36%) or less frequently one on a computer (6.7%), but most often they do not track the results (40.4%). A total of 55% of patient respondents are motivated to share their results electronically with their therapist. Conclusions: According to the survey results, patients with spastic paresis of the upper limb after brain injury are motivated to participate in remote therapy and share results of home exercise remotely. The application of innovative approaches in CIMT and activity monitoring increases the availability of therapeutic interventions with potential cost reduction in clinical practice.

MEMBANGUN MINAT BELAJAR MATEMATIKA MELALUI BIMBEL UNTUK SISWA SD Negeri No.067249 MEDAN

Smart and competitive generations are mainly produced by quality education. To improve the quality of human resources, non-formal and informal education are as important as formal education. Evaluating the impact of the free mathematics tutoring program implemented at SDN 067249 Medan is the goal of this community service project. This program aims to increase learning motivation and enable students of SDN 067249 Medan to understand the mathematics curriculum. Five times a week at the KKN Post, professors and students of STKIP AMAL BAKTI provide free education as part of the implementation approach. Although there are certain limitations such as implementation time and specific student demands, the results show a marked increase in student motivation and understanding and there is potential in this program