Time Of Visit Research Articles

Retinoblastoma patients treated in Sri Lanka from 2014 to 2020: epidemiology, clinical status and correlates of lag time in seeking tertiary care services

BackgroundRetinoblastoma (RB) is a tumour of children < 5 years with a incidence of 1 in 20,000. Around 20 RB cases are diagnosed yearly in Sri Lanka, a lower middle-income country with high literacy levels and healthcare free at point of delivery. Incidence, local and systemic severity and mortality related to RB are reportedly high in low- and middle- income countries in comparison to higher income countries. Aims of this study were to describe demographic, socioeconomic, and clinical characteristics of Sri Lankan RB patients attending the designated RB unit at the Lady Ridgeway Hospital (LRH), Colombo between January 2014 to December 2020, and determine correlates of lag time (LT) for first tertiary care visit after detecting the first symptom/sign.MethodsTwo descriptive cross-sectional studies (DCSS) were conducted, one on 171 RB patients with demographic and clinical data collected between 2017 and 2020. In 2021, the second DCSS took place where socioeconomic and further demographic data were collected using telephone interviews, recruiting a subgroup of 90 (53%), consenting and contactable RB patient/ parent pairs. Bivariate and multivariable analyses were applied to determine correlates of LT of > 4 weeks for first tertiary care visit. Results were expressed as odds ratios and 95% confidence intervals.ResultsLRH survey (N = 171): Median age at diagnosis was 15 months (range 1–94 months; IQR: 8–27); 89 (52%) were females. Groups D and E tumours were 25.7% (n = 44) and 62.6% (n = 107) respectively with 121 (71%) enucleations. The number of deaths were 2 (1.2%). Telephone survey (N = 90): Proportion with LT of > 4 weeks for first tertiary care visit was 58% (n = 52). None of the putative risk factors (ethnicity, parental educational level, socioeconomic status, distance from residence to tertiary care unit and receiving financial assistance) were associated with LT in both analyses.ConclusionDespite a high proportion with groups D and E tumours and enucleations, mortality rate was low, most likely due to availability of designated tertiary care. No correlates for LT of > 4 weeks for tertiary care presentation were identified. Early RB detection needs rigorous implementation of screening strategies and increased awareness among primary care health workers and parents.

Factors Affecting Length of Stays in the Emergency Department of a Teaching Hospital: A Retrospective Study From Najran, Saudi Arabia.

Reducing the frequency of emergency department (ED) patient visits for treatment, particularly in urgent instances, is a global healthcare objective. Additionally, a more extended stay in the ED can harm a patient's prognosis during later hospitalization. This study aims to investigate the factors affecting the length of stay in the ED in a teaching hospital. A retrospective chart review study was done between January 1, 2021, and February 31, 2021, involving 122 adult patients who had delayed ED visits to King Khalid Hospital in Najran, Saudi Arabia. Data on the patient's characteristics, visit time, and the causes for the delay based on the Canadian Triage and Acuity Scale (CTAS) were gathered and analyzed. Factors associated with more than six hours of delay were investigated in a univariate analysis. The mean age was 52.3 ±13.5 years, and 42 (34.4%) were more than 65 years of age. More than half of the study population were female (n=66; 54.1%). Most delays occurred among CTAS 4 and 5 cases (47.5%), and 22 (18.0%) occurred during holidays. The mean delay time was 6.1 ±1.8 hours. The leading delay causes were multiple consultations with further investigations (37.7%) and conflict between the teams (36.1%). In univariate analysis, ED visiting at holiday time (OR: 0.14; 95% CI: 0.04-0.40, p <0.001) and CTAS 4 and 5 (OR: 2.22; 95% CI: 0.95-5.30, p = 0.003) significantly had more delay. Factors associated with delay in univariate analysis were multiple consultations with further investigations (OR: 2.82; 95% CI: 1.32-6.26, p = 0.013), various assessments in different ED areas with a late arrival of the specialist (OR: 0.43; 95% CI: 0.20-0.91, p = 0.042), and conflict between the teams (OR: 2.50; 95% CI: 1.17-5.54, p = 0.031). In this study, multiple assessments in different ED areas and conflict between the teams were the main factors that caused delays in ED. Implementing a timeframe monitoring system for consultations while emphasizing accelerated decision-making and disposition for patients and understanding teamwork collaboration may reduce patients' length of stay in the ED. Implementing these strategies and evaluating their impact on the length of stay in the ED requires further investigation.

Dynamic undirected graphical models for time-varying clinical symptom and neuroimaging networks.

In this work, we propose methods to examine how the complex interrelationships between clinical symptoms and, separately, brain imaging biomarkers change over time leading up to the diagnosis of a disease in subjects with a known genetic near-certainty of disease. We propose a time-dependent undirected graphical model that ensures temporal and structural smoothness across time-specific networks to examine the trajectories of interactions between markers aligned at the time of disease onset. Specifically, we anchor subjects relative to the time of disease diagnosis (anchoring time) as in a revival process, and we estimate networks at each time point of interest relative to the anchoring time. To use all available data, we apply kernel weights to borrow information across observations that are close to the time of interest. Adaptive lasso weights are introduced to encourage temporal smoothness in edge strength, while a novel elastic fused- penalty removes spurious edges and encourages temporal smoothness in network structure. Our approach can handle practical complications such as unbalanced visit times. We conduct simulation studies to compare our approach with existing methods. We then apply our method to data from PREDICT-HD, a large prospective observational study of pre-manifest Huntington's disease (HD) patients, to identify symptom and imaging network changes that precede clinical diagnosis of HD.

The timing of visits by large and small bees differentially affects pollination success in Mimulus ringens.

Cross-fertilization in most flowering plants is facilitated by mobile animals that transport pollen while foraging for floral rewards. The contributions of different visitors can vary widely, depending on the amount of pollen transferred during a single visit and on the frequency and timing of the visits of each pollinator taxon. We used three approaches to measure the pollination value of bees that visit Mimulus ringens: pollinator interviews, field population observations, and caging studies. The single-visit effectiveness of small bees (primarily Halictidae) was only half that of larger bees (primarily Bombus) for pollen delivery and removal. In five field populations, we found substantial temporal and spatial variation in visitation and pollination. In most sites big bees were active before 08:00 hours, and by 10:00-11:00 hours, stigmas were usually fully pollinated and closed, and little pollen remained in anthers. Small bees seldom visited before 10:00 hours. Excluding big bees from plants confirmed that pollination is reduced and delayed in this ecological context. Big bees are the primary pollinators of M. ringens, accounting for at least 75% of seed production. Not only are they more effective per visit, in most situations they also visit before small bees become active. Although small bees are not usually important pollinators of M. ringens, they have the potential to partially replace them as a "fail-safe" pollinator in contexts where big bees are not abundant. In a world where pollinator abundance is declining, such backup pollinators may be important for maintaining plant reproduction.

Perceptions of structural and provider-based substance use stigma interventions among primary care professionals

BackgroundStigma enacted in primary care settings remains a barrier to care for people who use drugs (PWUD). Little is known about the acceptability of potential stigma interventions to target structural drivers of stigma affecting the organizational- or provider-level. MethodsIn-depth interview data were collected from 21 individuals working in Michigan primary care facilities. Participants included clinical (e.g., physicians, nurses) and non-clinical (e.g., administrators, receptionists) staff. Interviews explored perceptions of stigma toward PWUD and the acceptability of interventions to mitigate such stigma. Thematic analysis was used to identify stigma themes. ResultsParticipants largely reported substance-use stigma as a matter of individual attitudes or knowledge limitations and described such stigma as rarely occurring during interpersonal interactions. Participants were still acutely aware of upstream societal and organizational factors creating structural barriers to care and/or worsening outcomes among PWUD, but seldom labeled these as stigma. Some provider and structural stigma reduction interventions were enthusiastically supported because they address participant ideas of substance-use stigma drivers (e.g., lack of knowledge) or provide resources that could improve care quality or provide resources for PWUD. Conversely, participants opposed some potential stigma interventions, e.g., less-frequent urine drug testing and increasing clinical visit time, deemed infeasible because of outside forces like insurers or regulators. ConclusionsAlthough most participants conceptualized substance-use stigma as an individual or interpersonal process best addressed with training, their awareness of social determinants of health seemed to fuel an openness to some structural interventions to reduce organizational and provider stigma toward PWUD in primary care settings.

Assessment of women’s needs and wishes regarding interprofessional guidance on oral health in pregnancy – a qualitative study

BackgroundPoor oral and dental health due to oral dysbiosis during pregnancy increases the risk for negative pregnancy outcomes. Communicating the importance of oral health is therefore essential in reducing the risk of adverse pregnancy outcomes. Professional guidance could substantially support women’s positive perception of their own competence. Information on oral health should be provided by healthcare professionals such as midwives, obstetricians and dentists. The aim of this study was to assess the needs, wishes and preferences of pregnant women in Germany, regarding interprofessional collaboration and guidance on oral health during pregnancy.MethodsSources of information, preferences regarding information supply as well as the need for interprofessional collaboration of involved healthcare professions were investigated in six online focus groups with pregnant women. In addition, three expert interviews with a midwife, an obstetrician and a dentist were conducted. The focus groups and interviews were analysed using qualitative content analysis according to Kuckartz.Results25 pregnant women participated in focus groups. Pregnant women in all trimesters, aged 23 to 38 years, were included. Many women did not receive any or received insufficient information on oral health during pregnancy and wished for more consistent and written information from all involved healthcare providers. The extent of oral health counselling women received, heavily relied on their personal initiative and many would have appreciated learning about the scientific connection between oral health and pregnancy outcomes. An overall uncertainty about the timing and safety of a dental visit during pregnancy was identified. Interviews with experts provided additional insights into the working conditions of the involved healthcare professionals in counselling and emphasised the need for improved training on oral health during pregnancy in their respective professional education as well as thematic billing options in relation to this topic.ConclusionGuidance of women on oral health during pregnancy appears to be insufficient. Providing information adapted to the needs, wishes and preferences of women during pregnancy as well as the implementation of this topic in the education of involved healthcare professionals could contribute to an improved prenatal care for pregnant women and subsequently a reduced risk of negative pregnancy outcomes.

Timing of follow-up visits after hospital discharge for COPD: Application of a new method.

A common strategy to reduce COPD readmissions is to encourage patient follow-up with a physician within 1 to 2 weeks of discharge, yet evidence confirming its benefit is lacking. We used a new study design called target randomized trial emulation to determine the impact of follow-up visit timing on patient outcomes. All Ontario residents aged 35 or older discharged from a COPD hospitalization were identified using health administrative data and randomly assigned to those who received and did not receive physician visit follow-up by within seven days. They were followed to all-cause emergency department visits, readmissions or death. Targeted randomized trial emulation was used to adjust for differences between the groups. COPD emergency department visits, readmissions or death was also considered. There were 94,034 patients hospitalized with COPD, of whom 73.5% had a physician visit within 30 days of discharge. Adjusted hazard ratio for all-cause readmission, emergency department visits or death for people with a visit within seven days post discharge was 1.03 (95% Confidence Interval [CI]: 1.01-1.05) and remained around 1 for subsequent days; adjusted hazard ratio for the composite COPD events was 0.97 (95% CI 0.95-1.00) and remained significantly lower than 1 for subsequent days. While a physician visit after discharge was found to reduce COPD events, a specific time period when a physician visit was most beneficial was not found. This suggests that follow-up visits should not occur at a predetermined time but be based on factors such as anticipated medical need.

A Medical Student Experience as an Acting Intern in Colorectal Surgery

Gaining hands on clinical experience in the US as a medical student is an important prerequisite for securing a residency spot in the US. These clinical electives in surgery enable the medical student to witness the process of providing healthcare to patients from the time of the first clinic visit to the post operative recovery phase of the patient after surgery. This is especially crucial for international medical students who are used to a different type of medical system back in their home country. Getting an opportunity to rotate in the department of Colorectal surgery at the Cleveland Clinic is an opportunity of a lifetime. This is my experience at the Cleveland Clinic as an acting intern.

Using Wi-Fi Probes to Evaluate the Spatio-Temporal Dynamics of Tourist Preferences in Historic Districts’ Public Spaces

Tourist preferences for public spaces in historic districts can reflect whether renovated spaces and functional structures meet tourism demands. However, conventional big data lack the spatio-temporal accuracy needed to support a refined, dynamic study of small-scale public spaces inside historic districts. This paper, therefore, proposes using a Wi-Fi probe to evaluate the spatio-temporal dynamics of tourists’ spatial preferences in historic districts. We conducted a one-week measurement in the Xiaohe Street Historic Block in Hangzhou, China. Three indicators—visit time preference, aggregation preference, and stay preference—were used to examine the dynamic change in tourists’ spatial preferences, with 15 min as the time unit and public spaces with a radius of 25 m as the spatial unit. Our research demonstrates that, compared with conventional big data, the Wi-Fi probe offers a more reasonable and accurate method to measure tourists’ spatial preferences in historic districts at a smaller time and spatial granularity. The research findings can be applied to evaluate the effectiveness of spatial regeneration and diagnose renewal-related issues in historic districts. It can also serve as a foundation for more precise planning of public spaces in historic districts, as well as the modification of functional structures.

Refining Treat-to-Target (T2T) strategies in Cryopyrin-Associated Periodic Syndromes (CAPS): The role of inflammatory markers.

Cryopyrin-Associated Periodic Syndromes (CAPS) encompasses a spectrum of Interleukin-1 (IL-1) driven systemic diseases with dramatic individual and societal burden. The study aimed to identify parameters and instruments to refine real-life Treat-to-Target (T2T) strategies and control CAPS disease activity. A single-centre, longitudinal study of consecutive children and adults diagnosed with CAPS and treated with anti-IL-1 therapy was performed. Demographics, clinical phenotype and NLRP3 gene variants in addition to serial inflammatory markers and Physician and Patient/Parent Global Assessments (PGA/PPGA) were captured. Effectiveness of anti-IL-1 T2T strategies and factors associated with therapy escalation were determined. A total of 54 CAPS patients with 759 follow-up visits were included; 31/54 (57%) were children; the median follow-up was 108 months (12-620). The moderate CAPS phenotype was present in 89%; overall 59% had pathogenic/likely pathogenic NLRP3 variants. Therapy adjustments were documented in 50/759 visits including 35 therapy escalations and 15 reductions; 74% of the therapy escalation visits were for children. At time of visit, 63% showed moderate, 37% severe clinical disease activity. Inflammatory markers remained largely normal. Significant improvement was observed in both PGA/PPGA throughout the study (p< 0.01). At the last follow-up, 96% of patients achieved remission. Guidance for refining real-life T2T strategies in CAPS cohorts can be drawn from serial assessments of PGA and PPGA reliably reflecting changes in disease activity. Individual parameters including age and NLRP3 gene variants are important predictors, while the sensitivity of inflammatory markers is limited due to the confounding anti-IL-1 therapy.

Early detection of pediatric health risks using maternal and child health data

Machine learning (ML)-driven diagnosis systems are particularly relevant in pediatrics given the well-documented impact of early-life health conditions on later-life outcomes. Yet, early identification of diseases and their subsequent impact on length of hospital stay for this age group has so far remained uncharacterized, likely because access to relevant health data is severely limited. Thanks to a confidential data use agreement with the California Department of Health Care Access and Information, we introduce Ped-BERT: a state-of-the-art deep learning model that accurately predicts the likelihood of 100+ conditions and the length of stay in a pediatric patient’s next medical visit. We link mother-specific pre- and postnatal period health information to pediatric patient hospital discharge and emergency room visits. Our data set comprises 513.9K mother–baby pairs and contains medical diagnosis codes, length of stay, as well as temporal and spatial pediatric patient characteristics, such as age and residency zip code at the time of visit. Following the popular bidirectional encoder representations from the transformers (BERT) approach, we pre-train Ped-BERT via the masked language modeling objective to learn embedding features for the diagnosis codes contained in our data. We then continue to fine-tune our model to accurately predict primary diagnosis outcomes and length of stay for a pediatric patient’s next visit, given the history of previous visits and, optionally, the mother’s pre- and postnatal health information. We find that Ped-BERT generally outperforms contemporary and state-of-the-art classifiers when trained with minimum features. We also find that incorporating mother health attributes leads to significant improvements in model performance overall and across all patient subgroups in our data. Our most successful Ped-BERT model configuration achieves an area under the receiver operator curve (ROC AUC) of 0.927 and an average precision score (APS) of 0.408 for the diagnosis prediction task, and a ROC AUC of 0.855 and APS of 0.815 for the length of hospital stay task. Further, we examine Ped-BERT’s fairness by determining whether prediction errors are evenly distributed across various subgroups of mother–baby demographics and health characteristics, or if certain subgroups exhibit a higher susceptibility to prediction errors.

Risk factors for poor neurological recovery after anterior cervical discectomy and fusion: imaging characteristics

BackgroundPoor neurological recovery in patients after anterior cervical discectomy and fusion has been frequently reported; however, no study has analyzed the preoperative imaging characteristics of patients to investigate the factors affecting surgical prognosis. The purpose of this study was to investigate the factors that affect the preoperative imaging characteristics of patients and their influence on poor neurologic recovery after anterior cervical discectomy and fusion.MethodsWe retrospectively analyzed the clinical data of 89 patients who met the criteria for anterior cervical discectomy and fusion for the treatment of single-level cervical spondylotic myelopathy and evaluated the patients’ neurological recovery based on the recovery rate of the Japanese Orthopaedic Association (JOA) scores at the time of the final follow-up visit. Patients were categorized into the “good” and “poor” groups based on the JOA recovery rates of ≥ 50% and < 50%, respectively. Clinical information (age, gender, body mass index, duration of symptoms, preoperative JOA score, and JOA score at the final follow-up) and imaging characteristics (cervical kyphosis, cervical instability, ossification of the posterior longitudinal ligament (OPLL), calcification of herniated intervertebral discs, increased signal intensity (ISI) of the spinal cord on T2-weighted imaging (T2WI), and degree of degeneration of the discs adjacent to the fused levels (cranial and caudal) were collected from the patients. Univariate and binary logistic regression analyses were performed to identify risk factors for poor neurologic recovery.ResultsThe mean age of the patients was 52.56 ± 11.18 years, and the mean follow-up was 26.89 ± 11.14 months. Twenty patients (22.5%) had poor neurological recovery. Univariate analysis showed that significant predictors of poor neurological recovery were age (p = 0.019), concomitant OPLL (p = 0.019), concomitant calcification of herniated intervertebral discs (p = 0.019), ISI of the spinal cord on T2WI (p <0.05), a high grade of degeneration of the discs of the cranial neighboring levels (p <0.05), and a high grade of discs of the caudal neighboring levels (p <0.05). Binary logistic regression analysis showed that ISI of the spinal cord on T2WI (p = 0.001 OR = 24.947) and high degree of degeneration of adjacent discs on the cranial side (p = 0.040 OR = 6.260) were independent risk factors for poor neurological prognosis.ConclusionISI of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. A comprehensive analysis of the patients’ preoperative imaging characteristics can help in the development of surgical protocols and the management of patients’ surgical expectations.

A wireless, remotely operable and easily customizable robotic flower system

Abstract Understanding the complex interactions between external and internal factors that influence pollinator foraging behaviour is essential to understand ecosystem functioning, design agricultural practices or develop effective conservation strategies. However, it remains challenging to collect large and reliable data sets with reasonable personnel and workload. In this study, we present a wireless and cost‐effective robotic flower equipped with internet of things (IoT) technology that automatically offers nectar to visiting insects while monitoring visitation time and duration. The robotic flower is easy to manipulate and settings such as nectar refill rates can be remotely altered, making it ideal for field settings. The system transmits data completely wirelessly and autonomously, is mobile and easy to clean. The prototype settings allow for approximately 2 weeks of uninterrupted data collection for each battery charge. As a proof‐of‐concept application, a foraging preference dual choice experiment with bumblebees was performed. On average, more than 7000 flower visits per colony were registered daily with a set‐up consisting of 16 robotic flowers. The data show a gradual preference shift away from the pre‐trained low concentration, confirming the hypothesis of favouring sugar water with higher concentration. The robotic flower provides accurate and reliable data on insect behaviour, significantly reducing the price and/or labour costs. Although primarily designed for (bumble)bees, the system could be easily adapted for other flower‐visiting insects. The robotic flower is user‐friendly and can be easily adapted to address a wide range of research questions in pollination ecology, conservation biology, biocontrol and ecotoxicology, and allows for detailed studies on how nectar traits, flower colour and shape or pollutants affect foraging behaviour.

Flexible recommendation for optimizing the debt collection process based on customer risk using deep reinforcement learning

Finance sector loss can be minimized by reducing the number of defaulters who often miss payments during debt collection. Most research focused on the credit risk analysis before approving the loan to the customer, and few papers related to predicting the defaulters. Certain works are focused on minimizing the number of calls made by debt collectors during the collection process. We have developed a Flexible Recommender System using Deep Reinforcement Learning (FRS-DRL) to provide Flexible recommendations based on the risk category of the customers. Initially, we categorized customers into defaulters and non-defaulters. The defaulters are again classified into Very Low, Low, Medium, High, and Very High-Risk customers. Based on this category, we recommend suitable actions to the Field Collection Agent (FCA) to increase the collection rate. The suggestions include how frequently the customer should be contacted, statements, and the dates and times of visits. At the same time, the statements define instructions to FCA for collecting money. Managers are traditionally in charge of this type of allocation; they must understand each customer personally. Our proposed recommendation method eliminates the need for manual mapping. We build a Hybrid Actor-Critic algorithm with an Adaptive Trust region Policy Optimization algorithm for classifying the customer category and providing the appropriate recommendations to reduce the defaulter rate, thereby increasing the collection efficiency and reducing the human effort. This FRS-DRL is tested in a real-time environment for three months and provides an improved reward rate with and without transfer learning at 73.22 % and 62.44 %. The collection percentage improved by 20.34 % in five different regions, with a 16.30 % reduction in the number of visits made by the FCA.

Long-Term Efficacy of Teprotumumab in Thyroid Eye Disease: Follow-Up Outcomes in Three Clinical Trials.

Introduction: Thyroid eye disease (TED) is an autoimmune process characterized by extraocular muscle and orbital fat remodeling/expansion resulting in swelling, pain, redness, proptosis, and diplopia. Teprotumumab, an insulin-like growth factor-I receptor inhibitor, demonstrated improvements in TED signs and symptoms in three adequately powered clinical trials of 24 weeks duration. Here we analyze the long-term maintenance of responses with teprotumumab from these trials. Methods: A total of 112 patients who received 7 or 8 infusions of teprotumumab in the Phase 2, Phase 3 (OPTIC study), and OPTIC Extension (OPTIC-X) studies were included in this analysis. Responses, including clinical activity score (CAS ≥2-point improvement), the European Group of Graves' Orbitopathy ophthalmic composite outcome, diplopia (≥1 Gorman grade improvement), proptosis (≥2 mm improvement), Overall (improvement in proptosis + CAS), and disease inactivation (CAS ≤1), were assessed and pooled from study baseline to week 24 (formal study) and up to week 72 (formal follow-up). Graves' Ophthalmopathy quality-of-life (GO-QoL) scores were also assessed. Outcomes included the percentages of observed patient responsesfrom the study baseline. Additional alternative treatments for TED were assessed as a surrogate of persistent benefit from week 24 through week 120 (extended follow-up). Studies differed in the timing of follow-up visits, and data from some visits were unavailable. Results: At week 72, 52/57 (91.2%), 51/57 (89.5%), 35/48 (72.9%), 38/56 (67.9%), and 37/56 (66.1%) of patients were responders for CAS, composite outcome, diplopia, proptosis, and Overall response, respectively. The mean reduction in proptosis was 2.68 mm (SD 1.92, n = 56), mean GO-QoL improvement was 15.22 (SE 2.82, n = 56), and disease inactivation (CAS ≤1) was detected in 40/57 (70.2%). Over 99 weeks following teprotumumab therapy, 19/106 (17.9%) patients reported additional TED therapy during formal and extended follow-up. Conclusion: The long-term response to teprotumumab as observed 51 weeks after therapy was similar to week 24 results in the controlled clinical trials. Inflammatory and ophthalmic composite outcome improvements were seen in 90% of patients with nearly 70% reporting improvement in diplopia and proptosis. Further, 82% of patients in this analysis did not report additional TED treatment (including surgery) over 99 weeks following the final teprotumumab dose.

Screening for Pelvic Floor Disorders and Sexual Dysfunction in Postpartum Women: A Retrospective Cohort Study.

Objectives This study assesses the screen rate and prevalence of postpartum pelvic floor disorders and sexual dysfunction (PFDs/SD) within the first year of delivery. Methods This is a retrospective review of postpartum women seen in a university clinic who delivered at the associated hospital and had postpartum visits from June 1, 2020, to April 15, 2022. Charts were reviewed from delivery to one year postpartum. Demographic and clinical characteristics were compared between women with and without postpartum screening. Results Three hundred thirty-four women met inclusion criteria. Two hundred twenty (65.9%) were screened for PFDs/SD. Compared to women who were not screened, women who were screened were older (32.6 vs 31.3 years, p=0.02). Women with a cesarean delivery (73% vs. 58% vaginal, p=0.004), delivered by an attending or resident (70% vs 60% midwife, p=0.06), first postpartum visit at less than six weeks after delivery (76% vs. 43% 6-12 weeks, p<0.001), and three or more postpartum visits (80% vs. 65% two visits, 50% one visit, p<0.001) were more likely to be screened. In an adjusted model, only timing of the first postpartum visit remained significant. Urinary incontinence and fecal incontinence were the most common PFDs diagnosed.Of the 41 women who had PFDs and/or SD, 31 (75.6%) were referred to pelvic floor physical therapy (PFPT) and/or urogynecology. Discussion In this retrospective cohort study, we found a low rate of postpartum screening for PFDs/SDs. This deficiency highlights critical gaps in care for postpartum women.

Assessment of Recreational Activities and Greening of Urban-Parks in Kharkiv

Abstract Urban-parks, as sports and gaming locations, are a new type of landscape facilities in Ukraine, the first of which were created in Kharkiv. The three urban-parks in Kharkiv have been studied: Molodizhnyi, Saltivskyi and urban-park on Yuriyeva Bulevard. Recreational studies and plant inventories have been conducted to determine the popularity of the parks in 2021. The recreation surveys considered two indicators: the degree of recreation and the length of time visitors spent in the park. Field surveys were conducted in August and October. Saltivskyi urban-park was the most visited, and Molodizhnyi park was the least visited. The presence of playgrounds for pre-school children and children with disabilities makes Saltivskyy more attractive. The calculation of the average length of stay of the visitors on the territory showed that the visitors spend from 1,3 h/day to 1,77 h/day in the urban-parks. It is possible to identify shortcomings in the design of urban parks and make suggestions for their improvement based on the results of recreational load and greenery inventory assessment in urban-parks. The inventory showed that the area of green spaces in the urban-parks has decreased as a result of reconstruction. The level of greenery in Saltivskyi and Molodizhnyi urban parks is rather low and does not meet national regulatory requirements. There are 28 plant taxa of 11 families used in landscaping of the urban-parks, the greatest diversity in Molodizhnyi has been observed. It is necessary to optimize the existing assortment of plants. Some of them are not in a good sanitary condition, which has a negative impact on the overall decorative appearance of the plants and the parks in general.

Integrating patients in time series clinical transcriptomics data.

Analysis of time series transcriptomics data from clinical trials is challenging. Such studies usually profile very few time points from several individuals with varying response patterns and dynamics. Current methods for these datasets are mainly based on linear, global orderings using visit times which do not account for the varying response rates and subgroups within a patient cohort. We developed a new method that utilizes multi-commodity flow algorithms for trajectory inference in large scale clinical studies. Recovered trajectories satisfy individual-based timing restrictions while integrating data from multiple patients. Testing the method on multiple drug datasets demonstrated an improved performance compared to prior approaches suggested for this task, while identifying novel disease subtypes that correspond to heterogeneous patient response patterns. The source code and instructions to download the data have been deposited on GitHub at https://github.com/euxhenh/Truffle.

Increasing the Efficiency of Lifestyle Medicine Counseling: A Visual Approach.

Description Too much to counsel on, too little time? We would like to present a unique and innovative perspective on lifestyle medicine counseling through the lens of a homemade flyer, designed to bridge the gap between conventional health care practices and personalized, holistic well-being. In the promising field of health care humanities, the homemade lifestyle medicine flyer serves as a tangible manifestation of individual agency in promoting health and vitality. The flyer encapsulates a diverse range of self-care practices, dietary insights, and mindfulness techniques, emphasizing the inherent connection between mind, body, and spirit in one's health journey. This double-sided document highlights the significance of empowering individuals to take an active role in their own health journey. Included are a broad range of tips for building a solid health and well-being foundation, as well as a QR code with resources to make those changes happen. Patients may understand that they need to eat healthy foods and spend time outdoors but may not know how best to implement those changes in their area. Although there is limited time for the average office visit, something as simple as a visual aid can go quite far in creating ripples of change beyond the clinic. As a take-home document, it can become an opportunity to share and empower others in the patient's own sphere of influence as well. The flyer acts as a tangible artifact, becoming a conduit for fostering a sense of community engagement, encouraging dialogue, and promoting shared experiences in the pursuit of well-being.

Recruitment and Retention Strategies for Randomized Clinical Trials Involving Family Members of ICU Patients.

To review recruitment and retention strategies of randomized family-centered interventional studies in adult ICUs. The MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library database from inception to February 2023. Randomized controlled trials with family-centered interventions in the ICU setting that reported at least one family-centered outcome that were included in our previously published systematic review. For recruitment: Number of family members approached and enrolled, type of approach, location, time of day approached, whether medical team approached first, compensation offered, and type of consent. For retention: Number of family members enrolled and completed initial follow-up visit, mode of follow-up, location of follow-up visit, data collection method, timing of follow-up visits, number of follow-up visits, and compensation offered. Recruitment (participants approached/enrolled) and retention (participants enrolled/completed initial follow-up) percentage were calculated. There were 51 studies in the analysis. The mean recruitment percentage was 49.3% ± 24.3%. There were no differences in recruitment percentage by study country, ICU type, recruitment approach, or whether the medical team approached the family member first (all p > 0.05). The mean retention percentage for the initial follow-up visit was 81.6% ± 18.0%. There were no differences in retention percentage by mode of participant contact, data collection type, or follow-up location (all p > 0.05). Minimal data were available to determine the impact of time of day approached and compensation on recruitment and retention outcomes. About half of family members of ICU patients approached participated in trials and more than eight in ten completed the initial follow-up visit. We did not identify specific factors that impacted family recruitment or retention. There is a strong need for further studies to characterize optimal strategies to ensure family participation in clinical trials.