Time Of Visit Research Articles

Accommodating informative visit times for analysing irregular longitudinal data: a sensitivity analysis approach with balancing weights estimators

Abstract Irregular longitudinal data with informative visit times arise when patients’ visits are partly driven by concurrent disease outcomes. However, existing methods such as inverse intensity weighting (IIW), often overlook or have not adequately assessed the influence of informative visit times on estimation and inference. Based on novel balancing weights estimators, we propose a new sensitivity analysis approach to addressing informative visit times within the IIW framework. The balancing weights are obtained by balancing observed history variable distributions over time and including a selection function with specified sensitivity parameters to characterize the additional influence of the concurrent outcome on the visit process. A calibration procedure is proposed to anchor the range of the sensitivity parameters to the amount of variation in the visit process that could be additionally explained by the concurrent outcome given the observed history and time. Simulations demonstrate that our balancing weights estimators outperform existing weighted estimators for robustness and efficiency. We provide an R Markdown tutorial of the proposed methods and apply them to analyse data from a clinic-based cohort of psoriatic arthritis.

Consumer experiences of emergency department pre-triage waiting period: A mixed-methods study.

Emergency department pre-triage waiting periods have received limited attention. We aimed to explore the pre-triage experiences and perspectives of consumers attending emergency departments. This mixed-methods cross-sectional study included 92 participants (patients, carers, and guardians) who attended one of three public hospital emergency departments in metropolitan Melbourne (Victoria, Australia). Quantitative self-report outcomes were waiting time (minutes) and number of previous emergency department visits. Qualitative outcomes (explored through content analysis) were consumer experiences and perspectives of emergency departments in general and the pre-triage waiting period specifically. Participants reported a median (IQR) waiting time since triage of 45 (100) minutes and 65 % (n = 60) experienced a pre-triage waiting time of 3-90 minutes. The most common perception of the pre-triage waiting period was an expectation to wait (n = 16, 17 %), yet 46 % (n = 42) reported difficulties during this period, such as other patients cutting in queue (n = 6, 6.5 %). Few positives were associated with the pre-triage waiting period and suggestions to improve this period tended to focus on facilitating a queuing system (n = 18, 20 %). Consumers expected and understood triage, yet reported various difficulties and few positives during the pre-triage waiting period and suggested improvements to the current system, warranting investigation of interventions to improve queuing.

P0034 Glycosylation as new molecular mechanism underlying Pediatric Inflammatory Bowel Disease

Abstract Background Pediatric Inflammatory Bowel Disease (IBD) can be a highly disabling chronic condition. Genetic, immune and microbial factors have been associated with the development of IBD. Recent studies have shown that changes in glycosylation increase the susceptibility to immune-mediated diseases in adults, including IBD. This study aims to investigate, for the first time in pediatric population, if changes in glycosylation play a role in the immunopathogenesis of IBD, envisioning the identification of novel biomarkers and therapeutic targets. Methods We designed a cross-sectional study in which blood samples and fresh colonic biopsies from pediatric patients, either with Crohn’s Disease (CD) or Ulcerative Colitis (UC) or without IBD, were collected at the time of colonoscopy or outpatient visit in a tertiary hospital. T lymphocytes were isolated from colonic tissue and blood, and their glycosylation profile was analyzed by fluorescence-activated cell sorting using specific lectins that recognize different glycans structures and surface antibodies as markers of immune cells (CD45, CD4, CD8). Results A total of 80 participants were included, 24 without IBD and 56 with IBD. Among the IBD patients, 23 were diagnosed with Ulcerative Colitis (UC) and 33 with Crohn's Disease (CD). We observed that T lymphocytes from patients with CD exhibit a glycosylation profile alteration distinct from that seen in patients with UC and children without IBD, both at the level of the colon mucosa and in circulation (blood). The levels of a specific free glycan in peripheral blood circulation were higher in patients with Crohn's Disease compared to those with UC and non-IBD (p<0.05). Conclusion Our data suggest that CD patients may have a distinctive glycosignature that can be detected in circulation. This may represent a promising tool to discriminate CD patients from UC and non IBD, thus reducing the need for invasive exams in these patients. Overall, our findings may contribute to the identification of a novel diagnostic biomarker with clinical impact in decision-making algorithms, as well as therapeutic targets to improve disease control.

Time to first antenatal care visit and its predictors among women in Kenya: Weibull gamma shared frailty model (based on the recent 2022 KDHS data)

BackgroundThe first trimester of pregnancy is critical for fetal development, making early antenatal care visits essential for timely check-ups and managing potential complications. However, delayed antenatal care initiation remains a public health challenge in sub-Saharan Africa, including Kenya. Therefore, this study aimed to assess and provide up-to-date information on time to first antenatal care visit and its predictors among women in Kenya, using data from the most recent 2022 Kenya Demographic and Health Survey (KDHS).MethodsThis community-based cross-sectional study analyzed data from 19,530 birth histories in the 2022 Kenya Demographic and Health Survey (KDHS). The primary outcome was the timing of the first antenatal care (ANC) visit, classified as timely if it occurred in the first trimester. Shared frailty survival models were used to account for the hierarchical data structure and unobserved heterogeneity, with the Weibull gamma model identified as the best fit based on Information Criteria (AIC), and Bayesian Information Criteria (BIC). Variables with p < 0.2 entered multivariable analysis, and results were reported as Adjusted Hazard Ratios (AHR) with 95% Confidence Intervals (CI) using the Weibull gamma model.ResultsThe study found that the median time for the first antenatal care (ANC) visit in Kenya was four months. Significant predictors of ANC timing included women’s age (35–49 years: AHR 0.83; 95% CI: 0.72–0.95), education level (higher: AHR 1.45; 95% CI: 1.17–1.78), media exposure (yes: AHR 1.21; 95% CI: 1.05–1.39), parity (four or more children: AHR 0.81; 95% CI: 0.72–0.91), wealth status (richest: AHR 2.00; 95% CI: 1.63–2.43), desire for more children (did not want more: AHR 0.64; 95% CI: 0.54–0.77), residence (rural: AHR 1.22; 95% CI: 1.07–1.39), and religion (Islam: AHR 0.76; 95% CI: 0.64–0.89).ConclusionThe median time for the first ANC visit exceeds the World Health Organization’s recommendation of initiating care within the first trimester. These findings underscore the need for targeted interventions to promote timely ANC, especially among women with limited media exposure, high parity, lower socioeconomic status, and specific religious followers.

Time to evaluation and characteristics of patients evaluated at epilepsy centers within an integrated health care delivery system.

Rapid patient referral to epilepsy centers may facilitate subsequent disease-modifying surgical and non-surgical treatments. Delays of 15-18years have been reported from time of epilepsy diagnosis to surgical evaluation in some settings, though patterns for timely guideline-concordant referrals within integrated care models are not well known and could inform strategies for optimizing guideline-concordant access. We performed a retrospective cohort study of 1088 patients undergoing epilepsy center evaluation from January 1, 2008 through June 30, 2023 in a Northern California integrated healthcare delivery system (IDS) with a Level 4 Epilepsy Center. Using electronic health record (EHR) data, we summarized time from diagnosis and other major care time points until first visit at the epilepsy center. A multivariate linear model was used to evaluate the relationship of select demographic, socioeconomic, and clinical characteristics with the time to first epilepsy center visit. The mean times to epilepsy center visit from first prescription of an anti-seizure medication (ASM), diagnosis of epilepsy or seizures, and first visit with a general neurologist, were 3.9years (SD = 4.5), 3.2years (SD = 3.2) and 2.7years (SD = 3.2), respectively, for the full cohort of patients prescribed any number of ASMs. Comparable time frames were seen for patients prescribed two or more ASMs at the time of first visit. Significantly longer time to epilepsy center visit was seen in patients with multiple ASMs prescribed, a concordant diagnosis of developmental delay, and those age 40 and above. Longer times to epilepsy center visit were not seen among patients with psychiatric comorbidities, public health insurance coverage, and among patients in traditionally underserved groups. Patients evaluated at an epilepsy clinic within an IDS system did so within less than four years of diagnosis and initial treatment, with few disparities by demographics or comorbidities. Future studies can identify specific health system features that are key to shorter time frames to test transferable strategies to reduce time to epilepsy centers.

Crowdsourced Indicators of Flora and Fauna Species: Comparisons Between iNaturalist Records and Field Observations

Cultural ecosystem services provide intangible benefits such as recreation and aesthetic enjoyment but are difficult to quantify compared to provisioning or regulating ecosystem services. Recent technologies offer alternative indicators, such as social media data, to identify popular locations and their features. This study demonstrates how large volumes of citizen science and social media data can be analyzed to reveal patterns of human interactions with nature through unconventional, scalable methods. By applying spatial statistical methods, data from the citizen science platform iNaturalist are analyzed and compared with ground-truth visitation data. To minimize data bias, records are grouped by taxonomic information and applied to the metropolitan area of Seoul, South Korea (2005–2022). The taxonomic information included in the iNaturalist data were investigated using a standard global biodiversity database. The results show citizen science data effectively quantify public preferences for scenic locations, offering a novel approach to mapping cultural ecosystem services when traditional data are unavailable. This method highlights the potential of large-scale citizen-generated data for conservation, urban planning, and policy development. However, challenges like bias in user-generated content, uneven ecosystem coverage, and the over- or under-representation of locations remain. Addressing these issues and integrating additional metadata—such as time of visit, demographics, and seasonal trends—could provide deeper insights into human–nature interactions. Overall, the proposed method opens up new possibilities for using non-traditional data sources to assess and map ecosystem services, providing valuable information for conservation efforts, urban planning, and environmental policy development.

Association of a remote monitoring programme with all-cause mortality and hospitalizations in patients with heart failure: National-scale, real-world evidence from a 3-year propensity score analysis of the TELESAT-HF study.

To examine the association of a remote monitoring programme (RMP) with all-cause mortality and hospital admissions for heart failure (HF) within the French healthcare system. A national-scale, real-world, propensity-weighted cohort study was conducted using the SNDS French database from August 2018 to December 2022 (NCT06312501). Patients receiving standard of care (SoC) were compared with those receiving RMP (Satelia® Cardio, NP Medical). The Satelia® Cardio algorithm adjusted the monitoring frequency based on symptom and weight changes, and provided tailored web-based patient education. The RMP included a digital interface for proficient patients and phone monitoring by nurses for those uncomfortable with digital technology. Data were sourced from over 300 healthcare centres across France. A propensity-weighted Cox regression model was used, supplemented by sensitivity analyses across subgroups. In total, 5357 RMP patients and 13 525 SoC patients were included after weighting. Weighted/adjusted analyses showed lower all-cause mortality for RMP patients (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.59-0.70; p < 0.0001), persisting across hospitalization and/or long-term illness status subgroups (HR 0.52 to 0.75). RMP was neutrally associated with HF hospitalization rates (rate ratio [RR] 0.95; 95% CI 0.89-1.02) but linked to less time in hospital (-2.1%, p < 0.0001) and fewer emergency visits (RR 0.83; 95% CI 0.75-0.92; p = 0.001). In France, RMP with customized monitoring frequencies and educational strategies was associated with lower all-cause mortality, emergency visits, and time spent in hospital in patients with HF which may enhance nationwide HF management.

Factors Associated with the Timing of Initial Visit to Healthcare Providers for Injured Workers with Low Back Pain Claims: A Multijurisdiction Retrospective Cohort.

Evidence shows that patient outcomes following musculoskeletal injury have been associated with the timing of care. Despite the increasing number of injured workers presenting with low back pain (LBP) in primary care, little is known about the factors that are associated with the timing of initial healthcare provider visits. This study investigated factors that are associated with the timing of initial workers' compensation (WC)-funded care provider visits for LBP claims. We used a retrospective cohort design. A standardised multi-jurisdiction database of LBP claims with injury dates from July 2011 to June 2015 was analysed. Determinants of the time to initial general practitioner (GPs) and or musculoskeletal (MSK) therapists were investigated using an accelerated failure time model, with a time ratio (TR) > 1 indicating a longer time to initial healthcare provider visit. 9088 LBP claims were included. The median time to first healthcare provider visit was 3days (interquartile range (IQR) 1-9). Compared to General practitioners (GPs) (median 3days, IQR 1-8), the timing of initial consultation was longer if the first healthcare providers were MSK therapists (median 5days, IQR 2-14) (p < 0.001). Female workers had a shorter time to first healthcare provider visit [TR = 0.87; 95% CI (0.78, 0.97)] compared to males. It took twice as long to see MSK therapists first as it did to see GPs for injured workers [TR = 2.12; 95% CI (1.88, 2.40)]. Professional workers and those from remote areas also experienced delayed initial healthcare provider visits. The time to initial healthcare provider visit for compensable LBP varied significantly by certain occupational and contextual factors. Further research is needed to investigate the impact of the timing of initial visits to healthcare providers on claim outcomes.

A Comparison of Tourists’ Spatial–Temporal Behaviors Between Location-Based Service Data and Onsite GPS Tracks

Tourism and recreation managers rely on spatial-temporal data to measure visitors’ behavior for gauging carrying capacity and sustainable management. Location-based service (LBS) data, which passively record location data based on mobile devices, may enable managers to measure behaviors while overcoming constraints in labor, logistics, and cost associated with in-person data collection. However, further validation of LBS data at more refined spatial and temporal scales within tourism attractions is needed. We compared observations of salient spatial–temporal measures from a stratified sample of onsite visitors’ GPS traces in a popular U.S. National Park during peak season over two years with a sample of visitors’ traces collected during the same period by a third-party LBS data provider. We described trip characteristics and behaviors within 34 points of interest (POIs) and then pre-processed both datasets into weighted, directed networks that treated POIs as nodes and flow between POIs as edges. Both datasets reported similar proportions of day-use visitors (~79%) and had moderate-to-strong correlations across networks depicting visitor flow (r = 0.72–0.85, p &lt; 0.001). However, relative to the onsite data, LBS data underestimated the number of POIs the visitors stopped by and differed in its rank of popular POIs, underestimating the length of time visitors spent in POIs (z = 1, p ≤ 0.001) and overestimating visitation to the most popular POIs (z = 180, p = 0.044). Our findings suggest that LBS data may be helpful for identifying trends or tracking tourist movement in aggregate and at crude spatial and temporal scales, but they are too sparse and noisy to reliably measure exact movement patterns, visitation rates, and stay time within attractions.

Administration and Monitoring Burden of High-Efficacy Disease-Modifying Therapies for Multiple Sclerosis: A Delphi Consensus of Clinical Experts from Saudi Arabia.

The emergence of high-efficacy disease-modifying therapies (HE DMT) for multiple sclerosis (MS) may pose challenges to the administration and monitoring burden of the therapies. This article presents the results of the Delphi consensus method to generate insights from experts on the administration and monitoring burden of HE DMT in Saudi Arabia with a special focus on cladribine. Between January and March 2023, a two-round modified Delphi method was used to establish consensus regarding the administration and monitoring burden of HE DMTs used for MS. Through a questionnaire, the advisors evaluated 17 properties of six individual HE DMTs on the basis of their clinical experience. Advisors were required to rank each property on a scale of 1-5, with 1 being the lowest burden and 5 being the highest burden. Experts ranked cladribine as having the lowest monitoring burden, followed by ofatumumab and ocrelizumab. Natalizumab and fingolimod were ranked fourth, and alemtuzumab had the highest burden. During the first round, experts agreed on the scores of the administration burden properties, except for hospital visit time and facility use during administration for ofatumumab, route of administration for fingolimod, monitoring of specific side effects and frequency of lab tests at follow-up, and the washout period for natalizumab. During the second round, there was agreement on all properties. In the absence of alternative scientific data, recommendations from experts and their consensus provide useful insights into the administration and monitoring burden of HE DMTs used for MS in Saudi Arabia.

Estimating Visual Acuity With Spectacle Correction From Fundus Photos Using Artificial Intelligence

Determining spectacle-corrected visual acuity (VA) is essential when managing many ophthalmic diseases. If artificial intelligence (AI) evaluations of macular images estimated this VA from a fundus image, AI might provide spectacle-corrected VA without technician costs, reduce visit time, or facilitate home monitoring of VA from fundus images obtained outside of the clinic. To estimate spectacle-corrected VA measured on a standard eye chart among patients with diabetic macular edema (DME) in clinical practice settings using previously validated AI algorithms evaluating best-corrected VA from fundus photographs in eyes with DME. Retrospective cross-sectional evaluation of deidentified fundus photographs matched to spectacle-corrected VA determined by technicians on eye charts among patients with a history of DME based on optical coherence tomography and at least 2 visits within 1 to 6 months of each other at a university-based clinic between January 2014 and December 2022. Data were analyzed from January 2023 to October 2024. Previously validated AI algorithm evaluation of fundus photographs. AI-determined VA mean absolute error (MAE) compared with actual spectacle-corrected VA. Among 141 patients, the mean (SD) age was 63 (13) years, 71 (50%) were male, 2 (1%) were Asian, 42 (30%) were Black or African American, and 88 (63%) were White. Among 282 eyes at visit 1, 66 had nonproliferative diabetic retinopathy (NPDR) and DME, 38 had proliferative diabetic retinopathy (PDR) and DME, 101 had NPDR and no DME, and 77 had PDR and no DME. Among 564 images (282 eyes) at both initial and follow-up visits, MAE (SD) among eyes with NPDR, with or without center-involved DME (CI-DME), was 1.16 (1.00) lines on the eye chart for VA between 20/10 and 20/20 (67 images), and 1.44 (1.15) lines for between VA 20/25 and 20/80 (231 images). MAE (SD) among eyes with PDR, with or without CI-DME, was 1.92 (1.08) lines for VA between 20/10 and 20/20 (50 images), and 1.42 (0.97) lines for spectacle-corrected VA between 20/25 and 20/80 (150 images). Only 65 images had VA 20/100 or worse, precluding meaningful analyses. In this cross-sectional study, AI evaluation of fundus photographs among patients with DME and VA 20/80 or better estimated spectacle-corrected VA within approximately 1 to 1.5 lines of actual spectacle-corrected VA. These results support use of AI evaluation of fundus photographs to determine spectacle-corrected VA among patients with DME globally, beyond ophthalmology offices.

Predictive value of the systemic inflammatory response index and APACHE II score for acute respiratory distress syndrome caused by wasp stings.

This study aimed to assess the predictive value of the systemic inflammatory response index (SIRI) and APACHE II score for acute respiratory distress syndrome (ARDS) resulting from wasp stings. A retrospective study was conducted, including patients who suffered wasp stings and developed ARDS between January 2018 and November 2024 in the Shiyan area of Hubei province. Based on the 28-day prognosis, patients were categorized into two groups: survivors (n=21) and non-survivors (n=25). Clinical data, including demographic characteristics, sting site, clinical symptoms, laboratory findings, and treatment measures, were collected. Univariate and multivariate logistic regression analyses were performed to evaluate the predictive roles of SIRI and APACHE II scores in ARDS prognosis, and their clinical predictive value was assessed using ROC curves. Significant differences were observed between the survivor and non-survivor groups in APACHE II scores, number of stings, and length of hospitalization (P<0.05). However, factors such as gender, time of first visit, and site of stings showed no statistically significant differences (P>0.05). Leukocyte counts, SIRI, and APACHE II scores were significantly lower in the survivor group compared to the non-survivor group (P<0.05). Multivariate logistic regression analysis revealed that the APACHE II score (OR=1.42, 95% CI: 1.12-1.79, P=0.004) and SIRI (OR=1.27, 95% CI: 1.07-1.49, P=0.005) were significant independent predictors of 28-day mortality in ARDS patients. ROC curve analysis showed that the AUC for early SIRI was 0.821 (95% CI: 0.693-0.949, P<0.001), while the AUC for the APACHE II score was 0.809 (95% CI: 0.681-0.936, P<0.001), indicating that both measures have high clinical predictive value. This study demonstrated that the APACHE II score and SIRI are valuable tools for predicting the prognosis of ARDS patients caused by wasp stings. Early elevation of these markers is closely associated with an increased risk of mortality and can serve as an effective means of assessing disease severity and mortality risk.

Effects of flowering period on floral traits, pollinator behavior and seed production of David’s mountain laurel (Sophora davidii)

ABSTRACT Sophora davidii is a cross-pollinated plant with important ecological protection and medicinal value in China, but its seed yield is low due to backward and nonstandard production technology. Therefore, we divide the flowering period of Sophora davidii into initial, full and final flowering period, measuring the floral morphology, pollen viability, stigma receptivity, nectar volume and nectar concentration, foraging behavior of pollinators, fertilization physiology, seed yield and quality through field observation and indoor testing to explore whether the flowering period affects the floral traits, pollinator behavior and seed production of plants. Our results revealed that the nectar volume, nectar concentration, pollen viability and stigma receptivity at full flowering period were the highest. The single visit time and visit time per flower of Chinese honey bees were the longest in the full flowering period, while the number of transfer, visit frequency and number of touching stigma were the least. The visiting number of the bees was the most and the most active in the full flowering period. The bees pollination not only improved the pollen amount, germination rate, pollen tube length and the ovule number of S. davidii, but also their effect was the most obvious in full flowering period. The principal component analysis showed that pollination by Chinese honey bees during the whole flowering period of S. davidii was the best way to produce seeds. We can conclude that flowering period affects flower traits, foraging behavior of pollinators, seed yield and quality of S. davidii.

Maternal factors affecting foetal outcome in rural area of district Amritsar, Punjab

Background: Birth weight not only indicates health of mother, nutrition and quality of life but also a pivotal factor in determining growth, survival and development of children. The key aspect influencing birth weight is maternal factors. Stress during pregnancy also affects a child's growth and development. So the present study was planned to assess the maternal factors affecting foetal outcomes. The level of stress among antenatal women was also determined in the study. Methods: A prospective observational type of study was conducted from January to March, 2022. All the registered antenatal women were followed till outcome of pregnancy. Information was collected on predesigned and pretested proforma. Data analysis was done using SPSS version- 23. Results: A total of 114 antenatal were registered in rural field practice area under Department of Community Medicine, SGRDIMSAR, Amritsar. There were 108 singleton live births and 6 miscarriages among registered antenatal women. Almost half (47.2%) of subjects got their pregnancy registered before 12 weeks. Recommended more than minimum 4 antenatal visits were conducted in almost half (49.1%) of women. Three fourth (75.9%) women in first trimester of pregnancy were suffering from moderate stress while 24.1% women were suffering from low stress. Conclusions: In the present study maternal factors found to be significantly associated with birth weight of newborn were maternal age at first child, timing of 1st Antenatal visits, weight gain during pregnancy, number of Td (Tetanus diptheria) doses taken and consumption of IFA tablets. Perceived stress score (PSS) was also found to be significantly associated with birth weight of newborn.

Recommendations for the optimization of student led free vision screening programs

PurposeTo report the summary characteristics of operational models associated with Student Led Free Vision Screening Programs (SLFVSP) and to identify opportunities for program optimization.MethodsAn 81-question mixed methods survey was distributed to SLFVSP leaders nationwide and Medical Student Educators within the American University Ophthalmology Professors (AUPO) Association. Survey responses were analyzed using Mann Whitney U and Fisher’s Exact tests. Themes considering the assets and liabilities of SLFVSPs were summarized using self-reported qualitative data from survey responses. Qualitative and quantitative themes considering were then synthesized into a Strengths, Weaknesses, Opportunities, & Threats (SWOT) analysis for a collective appraisal of SLFVSP operations. Finally, drivers were identified to generate change ideas to improve SLFVP operations through a collaborative, quality improvement model.ResultsA total of 16 survey responses were included from programs operational for a median of 6 years. Most respondent programs (n = 9) reported year-long operations; no preference between weekday (n = 8) and weekend (n = 7) screening activities was identified. Programs obtained funding from a diverse array of internal and external sources. There was no significant difference in wait time for scheduled appointments compared to a walk-in strategy; overall door-to-door visit times ranged from 15 min to 120 min. Screenings were held in several locations, most commonly in Federally Qualified Health Centers (n = 8) and religious centers (n = 6). Most screening event volunteers were first- and second-year medical students. The qualitative thematic analysis demonstrated that the most commonly self-reported asset was improving access to scarce vision screening services (n = 7) while the most commonly self-reported liability was difficulty recruiting faculty and/or resident for oversight (n = 5). The SWOT analysis revealed while the participant SLFVSPs were bolstered by site experience, community and corporate partnerships for glasses and space to hold vision screening, and institutional support from academic ophthalmology departments, limitations included difficulty with recruitment, space limitations, and poor follow-up care infrastructure.ConclusionCollaborative standardization of SLFVSP operations can promote targeted staff training, organizational stewardship, and consensus building to ensure SLFVSP can offer sustainable vision screening programs that build vision equity at the community level.

Timing of Carpal Tunnel Syndrome Treatment Based on Social Deprivation.

This study sought to investigate the impact of the area deprivation index (ADI) on the treatment timeline from carpal tunnel syndrome (CTS) to carpal tunnel release (CTR). We hypothesize that increased social deprivation will correlate with increased time between care milestones from presentation to surgery. This is a retrospective review of patients diagnosed with CTS who underwent CTRat a single academic institution. Variables including gender, race, ethnicity, smoking status, medical comorbidities, ADI, timing of visits and surgery, and electrodiagnostic (EDX) studies were collected. The analysis included univariate chi-square tests, ANOVA, and multivariate linear and logistic regressions. In total, 501 patients were divided by ADI national percentiles from least to most deprived tertiles. Univariate analysis demonstrated increased time from EDX to CTR comparing the least and most deprived tertiles (52 days vs. 95 days). On multivariate analysis, this correlation was no longer significant. Multivariate analysis also revealed a non-significant trend towards least deprived ADI correlating with a trial of corticosteroid injections. Injections prior to surgery correlated with an increased time from EDX to CTR and time from initial presentation to CTR. A diagnosis of severe CTS on EDX correlated with a decreased likelihood of corticosteroid injections. Although previous studies have demonstrated mixed outcome results in CTS, we found that social deprivation does not correlate with delays in the treatment timeline. Factors other than delays in the treatment timeline may be contributing to the potentially worse outcomes in CTS patients with greater social deprivation.

How multi-species pollination boosts strawberry yield, quality, and nutritional value

A diverse assemblage of insect visitors can provide functional complementarity within plant pollination due to differences in characteristics such as their physical traits, visitation rate and foraging time of day or year. In a horticultural context, greater functional complementarity may play a crucial role in enhancing fruit yield and quality by improving pollination. We tested whether the identity of the crop pollinators (bumblebee Bombus terrestris and hoverfly Eupeodes corollae) independently and additively influenced commercial strawberry yield, quality, and nutritional parameters such as vitamin C and sugar concentration. Fragaria x ananassa “Malling Champion” plants received pollination treatments of either a) “control”: self-pollination where pollinators were excluded, b) “bee”: bumblebee Bombus terrestris, c) “hoverfly”: Eupeodes corollae, d) “combined”: both B. terrestris and E. corollae. Hoverflies and bumblebees exhibited distinct visitation patterns throughout the day, establishing a functional complementary relationship that enhances pollination success and crop output as well as vitamin C concentrations. Strawberries from plants receiving pollination by bumblebees, or bumblebees and hoverflies combined, had higher yields of higher marketable quality. They also had measurably higher vitamin C content than strawberries from plants pollinated by hoverflies alone, or the control (self-pollinating) plants. This study advances our understanding of niche complementarity and its impact on fruit yield and quality. By elucidating the behavioural and temporal dynamics of pollinators, we provide valuable insights for optimizing pollination strategies in agricultural contexts. Our findings highlight the significance of behavioural factors, such as handling time and number of visits, in determining fruit quality.

Real-world utility of ChatGPT in pre-vasectomy counselling, a safe and efficient practice: a prospective single-centre clinical study.

This study sought to assess if pre-vasectomy counselling with ChatGPT can safely streamline the consultation process by reducing visit times and increasing patient satisfaction. A single-institution randomized pilot study was conducted to evaluate the safety and efficacy of ChatGPT for pre-vasectomy counselling. All adult patients interested in undergoing a vasectomy were included. Unwillingness to provide consent or not having internet access constituted exclusion. Patients were randomized 1:1 to ChatGPT with standard in-person or in-person consultation without ChatGPT. Length of visit, number of questions asked, and a Likert scale questionnaire (on a scale of 10, with 10 being defined as great and 0 being defined as poor), were collected. Descriptive statistics and a comparative analysis were performed. 18 patients were included with a mean age of 35.8 ± 5.4 (n = 9) in the intervention arm and 36.9 ± 7.4 (n = 9) in the control arm. Pre-vasectomy counselling with ChatGPT was associated with a higher provider perception of patient understanding of the procedure (8.8 ± 1.0 vs. 6.7 ± 2.8; p = 0.047) and a decreased length of in-person consultation (7.7 ± 2.3min vs. 10.6 ± 3.4min; p = 0.05). Quality of information provided by ChatGPT, ease of use, and overall experience were rated highly at 8.3 ± 1.9, 9.1 ± 1.5, and 8.6 ± 1.7, respectively. ChatGPT for pre-vasectomy counselling improved the efficiency of consultations and the provider's perception of the patient's understanding of the procedure.

The Impact of Language Discordance on Acquiring Broad Social History: A Qualitative Study of Patients, Clinicians, and Interpreters.

By acquiring a broad social history (BSH), which includes aspects of patients' social needs in addition to their hobbies and activities, values, and perspectives on care, clinicians can provide more patient-centered care, which is known to improve health outcomes. However, the impact of patient-clinician language discordance on acquisition of BSH has not been well studied. To ascertain whether language discordance impacts clinicians' acquisition of patients' BSH by interviewing patients, clinicians, and medical interpreters. Qualitative study based on semi-structured interviews, followed by thematic analysis using rapid qualitative data analysis methods. We interviewed 8 Spanish-speaking and 5 English-speaking patients seen for primary care within a public hospital in San Francisco, 6 primary care clinicians, and 8 medical interpreters. All interviews were recorded and transcribed. The transcriptions were summarized into domains using rapid qualitative data analysis. The summaries were displayed in a matrix and used to generate themes and subthemes. Analysis of interviews highlighted two overarching themes concerning BSH acquisition. One theme was the importance of BSH: namely, it is critical for patient-clinician relationships and personalized care. Commonly elicited BSH facets were social drivers of health, but leisure activities were less frequently asked. The second theme described ways in which language discordance, via the need for interpretation, affects the collection of BSH, both through increasing time pressure, and hindering rapport-building strategies. Cultural barriers pose an obstacle to BSH acquisition and may operate independently of language discordance. Our results suggest two action steps for health systems: (a) apportioning more time for language-discordant visits to increase rapport-building and BSH acquisition, and (b) increasing training for clinicians on acquiring BSH when working with interpreters. Further research is needed to investigate the relationship between language discordance, acquisition of BSH, and patient outcomes.

Association of Initial Side of Brain Atrophy With Clinical Features and Disease Progression in Patients With GRN Frontotemporal Dementia.

Pathogenic variants in the GRN gene cause frontotemporal dementia (FTD-GRN) with marked brain asymmetry. This study aims to assess whether the disease progression of FTD-GRN depends on the initial side of the atrophy. We also investigated the potential use of brain asymmetry as a biomarker of the disease. Retrospective examination of data from the prospective Genetic Frontotemporal Initiative (GENFI) cohort study that recruits individuals who carry or were at risk of carrying a pathogenic variant causing FTD. GENFI participants underwent a standardized clinical and neuropsychological assessment, MRI, and a blood sample test yearly. We generated an asymmetry index for brain MRI to characterize brain asymmetry in participants with or at risk of FTD-GRN. Depending on the side of the asymmetry, we classified symptomatic GRN patients as right-GRN or left-GRN and compared their clinical features and disease progression. We generated generalized additive models to study how the asymmetry index evolves in carriers and noncarriers and compare its models with others created with volumetric values and plasma neurofilament light chain. A total of 399 participants (mean age 49.7 years, 59% female) were included (63 symptomatic carriers, 177 presymptomatic carriers, and 159 noncarriers). Symptomatic carriers showed higher brain asymmetry (11.6) than noncarriers (1.0, p < 0.001) and presymptomatic carriers (1.0, p < 0.001), making it possible to classify most of them as right-GRN (n = 21) or left-GRN (n = 36). Patients with right-GRN showed more disease severity at baseline (β = 6.9, 95% CI 2.4-11.0, p = 0.003) but a lower deterioration by year (β = -1.5, 95% CI -2.7 to -0.31, p = 0.015) than patients with left-GRN. Brain asymmetry could be found in GRN carriers 10.4 years before the onset of the symptoms (standard difference 0.85, CI 0.01-1.68). FTD-GRN affects the brain hemispheres asymmetrically and causes 2 anatomical asymmetry patterns depending on the side of the disease onset. We demonstrated that these 2 anatomical asymmetry patterns present different symptoms, severity at the time of the first visit, and different disease courses. Our results also suggest brain asymmetry as a possible biomarker of conversion in GRN carriers.