Time Of Visit Research Articles

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.

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.

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.

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.

Human trafficking screening in Saskatoon Emergency Departments: What can be learned from high-risk patient presentations?

ObjectiveStudies have shown that Emergency Department physicians have little to no training in recognizing and supporting victims of human trafficking despite being uniquely situated to identify and intervene on behalf of these patients. We assessed if screening for human trafficking was being completed by emergency physicians in three Saskatoon emergency departments.MethodsWe performed a retrospective chart review of patients presenting to three Saskatoon emergency departments deemed to potentially be at risk of human trafficking, based on discharge diagnosis. Of the 223 included charts, data extracted included sex, age, ethnicity, chief complaint, diagnosis, disposition, HT Screening (Y/N), specific quotes relating to HT, time of visit, intimate partner violence (Y/N), and travel history. Both quantitative and qualitative thematic analyses were conducted on this data.ResultsNone of the charts (0%) included in this study had any documentation around screening for human trafficking. Furthermore, 21.1% of the high-risk patient charts included in this study -- which included many patients with a discharge diagnosis of sexually transmitted disease or pelvic inflammatory disease -- did not contain a documented sexual history. Thematic analysis revealed that the patients included in this study frequently had challenges with sexual health, substance use, and houselessness.ConclusionThis study found that Emergency physicians in Saskatoon were not routinely screening for human trafficking. Implementation of further training is needed to help these physicians recognize and subsequently support potential victims of human trafficking.

Experiences with Internships: Perceptions of Undergraduate Publishing Students at the Kwame Nkrumah University of Science and Technology, Ghana

The Industrial internship is the platform that enables students to experience the practical aspects of what they learn outside the classroom. The internship is a facilitator that allows students to put into practice what they have learned in school. The study assessed students’ opinions of their internship experience to identify the strengths and weaknesses of the system. Data were collected from 160 students from the Publishing Department. The survey instrument used to gather information and data from the respondents was a well-structured questionnaire consisting of 37 test items. The students responded to the questionnaire using Google Forms, which were sent to the sampled students. Data were analysed using descriptive statistics. The results of the study showed that most of the interns felt that the courses they took on campus before the internship improved their understanding of the issues they encountered at the workplace during the internship. Most respondents believed that industrial placement improves interns’ career choices. The respondents recommended that the University reviews the staff visit times at the companies where students undertake their internships. Respondents also cited financial challenges as the biggest problem during the internship programme. Students enjoyed completing internships in industry, and believe that it will enhance their career goals and job opportunities. The study presents a clear road map to strengthen the Student Internship programme and contribute immensely to the industry’s growth. Also, the publishing industry can leverage on the findings to improve its internship policy. Keywords: Industrial Internship, Internship Experiences, Undergraduate Students, Perceptions, Learners.

Decoding morbidity patterns in ASHA workers of Vadodara, Gujarat - A cross-sectional study.

Accredited Social Health Activists (ASHA) play a pivotal role as village-level functionaries under the National Health Mission, driving community transformation, facilitating health planning, and ensuring access to healthcare services. To assess the physical health status of ASHA workers and to investigate the prevalence of morbidities among ASHA workers. This is a cross-sectional study, conducted in Vadodara's east zone, and involves 123 ASHA workers. A questionnaire focusing on health profiles, encompassing age, weight, height, body mass index, and blood pressure, as well as histories of acute and chronic illnesses, was employed for data collection. Descriptive statistics were employed to summarize demographic and professional characteristics, and inferential statistics, such as Chi-square tests, were applied to assess associations and factors influencing the morbidity profile of the ASHA workers. The participant's mean age was 38.9 ± 6.85 years. The majority, 74 (60.2%), of them reported no morbidity, whereas 40 (32.52%) had a chronic illness and 9 (7.32%) had acute morbidity at the time of visit. Among the chronic morbidity, 50% of ASHA had poly morbidity. Anemia was found among most ASHAs, 32 (26.02%), followed by diabetes, 19 (15.45%), and hypertension, musculoskeletal problems, thyroid disorders, and obesity were the other major diseases found among the ASHAs in 14.63%, 13.82%, 13.01%, and 11.38%, respectively. Skin problems like fungal infection and rashes were found among 5.69%. Based on body mass index, 27 (21.95%) were found overweight and 14 (11.38%) were obese. The study revealed a 32% chronic morbidity prevalence among ASHA workers who are taking care of citizens' health. It is high time to take care of our health team. First, they should be healthy as they are the role models of the community.

Characteristics of patients enrolled in hospice presenting to the emergency department.

Emergency Departments (EDs) frequently care for patients with life-limiting illnesses, with nearly 1 in 5 patients enrolled in hospice presenting to an ED during their hospice enrollment. This study investigates the reasons patients enrolled in hospice seek care in the ED, the interventions they receive, and their outcomes. Multicenter, retrospective cohort study of patients enrolled in hospice who presented to an ED within a health system between 2018 and 2023. Descriptive analysis included patient characteristics, chief complaint, interventions, disposition, ED return visits and mortality. Comparisons were made via logistic regression between patients with a hospice enrollment diagnosis of cancer vs non-cancer diagnosis, patients enrolled in hospice for <30days vs those enrolled for ≥30days, and patients admitted to the hospital compared with patients not admitted. A total of 119 ED visits by patients enrolled in hospice were identified. Patient median age was 85 (IQR: 68-92) years, 38% were female, and 86% were White. Hospice diagnoses included cancer (31%), heart disease (21%), lung disease (13%), and dementia (13%). At the time of ED visit, patients were enrolled in hospice for a median of 71 (IQR: 17-162) days. Patients primarily presented via emergency medical services (EMS) (76%) from a home residence (51%). The most common reasons for ED visit were trauma (36%), pain (15%) and catheter/tube malfunction (12%). Most patients received laboratory studies (60%), medications (66%) and imaging (64%). A total of 45% were admitted to the hospital, with 2% expiring in the ED. Patients admitted to the hospital were more likely to be receiving hospice services at home (66% vs. 34%, p=0.003). Seven-day mortality was 20% and 30-day mortality was 38%. Ten percent returned to the ED within 7days and 17% within 30days. Patients enrolled in hospice for ≥30days were less likely to return (30% vs. 51%, OR 0.26, 95% CI 0.075-0.94) or die (30% vs 51%, OR 0.40, 95% CI 0.19-0.87) within 30days compared to those enrolled for <30days. Patients with a hospice diagnosis of cancer were more likely to die within 7days (32% vs 15%, OR 2.78, 95% CI 1.11-7.04) compared to patients with a non-cancer hospice diagnosis. In addition, those with a cancer hospice diagnosis (62% vs 27%, OR 4.48, 95% CI 1.96-10.22) and those admitted to the hospital (48% vs 16%, OR 2.38, 95% CI 1.11-5.11) were more likely to die at 30days than those with a non-cancer enrollment diagnosis or those not admitted, respectively. Patients enrolled in hospice most frequently presented to the ED for trauma. Most received laboratory studies and imaging. Nearly half of patients were admitted to the hospital and short-term mortality was high, particularly for patients enrolled in hospice for <30days, enrolled with a hospice diagnosis of cancer, or admitted to the hospital. Understanding the care patients enrolled in hospice receive in the ED can help prevent avoidable visits and ensure care aligns with patients' goals.

"What Matters" in the Emergency Department: A Prospective Analysis of Older Adults' Concerns and Desired Outcomes.

To describe "What Matters" to older adults seeking emergency department (ED) care and to identify patient characteristics associated with meeting desired outcomes. As part of the 4Ms framework, identifying "What Matters" has been captured across healthcare settings, yet limited attention has been directed to older adults in the ED. We performed a secondary analysis of a multicenter prospective observational study. The study enrolled 1013 patients aged 65 and older during an ED encounter and performed 90-day follow-up interviews. The primary outcome was the quantification of "What Matters" (concerns and desired outcomes) to older adults during emergency care. As secondary outcomes, we assessed concerns at day 90, if desired outcomes were met at follow-up, and patient characteristics associated with outcome achievement by estimating multivariable logistic regression models. Older adults reported specific concerns at the time of the ED visit including: (1) symptom identification and/or persistence (31.4%), (2) ability to take care of oneself (19.4%), and (3) end-of-life (17.8%). Desired outcomes expressed by participants included: (1) getting well and symptom resolution (72.0%), (2) obtaining a diagnosis (25.7%), and (3) functional independence (19.5%). At day 90 follow-up, concerns remained similar to the initial ED visit, and the majority of participants (66.2%) achieved their desired outcome. Frailty (adjusted odds ratio = 0.56, 95% CI: 0.38-0.83, P < 0.01) was associated with older adults not meeting their desired outcomes. Older adults identified a variety of concerns during emergency care, and two-thirds reported that desired outcomes were met at longitudinal day 90 follow-up.

Exploring sources of (co-)variation in timing and total daily feeder visits in a wild population of black-capped chickadees.

The timing and amount of foraging in birds are shaped by many of the same extrinsic factors, including temperature and daylength, as well as intrinsic factors, such as sex and age. Here, we investigate co-variation between these traits. We observed a population of 143 individually marked black-capped chickadees (Poecile atricapillus) over a 90 day period during the winter. For each day, we recorded the time an individual began and ended feeder use relative to sunrise/sunset, and the total number of feeder visits. Within-individuals, both earlier first feeder visit and later last feeder visit were associated with higher total daily feeder visits but lower feeding rates. Individuals also differed consistently in the timing of first and last feeder visits, and individuals that consistently started feeder use earlier in the day ended feeder use later and had higher total daily feeder visits compared with those that started later, but had no difference in feeding rate. Our study demonstrates that variation in the timing of foraging can have important consequences for energy acquisition at both the within- and among-individual levels.

Effects of a sorbitol-containing additive fed to dairy cows for 30 days postpartum.

The objective of this study was to determine the effects of early postpartum supplementation of Rally®, a sorbitol-containing feed additive (RAL), on lactation performance and automatic milking system (AMS) metrics on a commercial dairy farm. Multiparous (MT) and primiparous (PP) Holstein cows were randomly assigned to either RAL supplementation (570 g/d RAL; RAL-MT, n = 75, RAL-PP, n = 34) or control (CTL-MT, n = 72; CTL-PP, n = 38). The RAL cows were supplemented from 1 to 30 d in milk via an automated feed dispenser in the AMS. Milk production and other metrics were recorded for 1 to 90 DIM. Outcomes were analyzed with a linear mixed effect model with repeated measures. Analyses were conducted separately for the 2 periods: supplementation (1-30 DIM) or post-supplementation (31-90 DIM). Multiparous cows fed RAL produced 3.52 ± 1.29 kg more ECM per day than CTL cows during the supplementation period. The number of refusal visits/d to the AMS (visits when was not time for cows to be milked) during the supplementation period was 0.66 fewer for multiparous cows fed RAL than CTL cows. Daily milk yield and ECM yield, and number of refusal visits/d were similar for primiparous cows fed RAL or CTL during the supplementation period. Multiparous cows fed RAL continued to produce 2.17 ± 1.11 kg more ECM per day than CTL cows during the post-supplementation period. Rumination time during the post- supplementation period was 12.5 min less for multiparous cows fed RAL than CTL cows. The number of refusal visits/d during the post-supplementation period was 0.59 fewer for multiparous cows fed RAL compared with CTL cows. Daily milk yield and ECM yield, rumination time, and number of refusal visits per day during the post-supplementation period were similar between primiparous cows fed RAL and CTL cows. The results from this study indicate that RAL supplementation during the first 30 DIM increased milk yields when fed to multiparous cows.

Shelter or complexity? Nile tilapia (Oreochromis niloticus) preference for enrichment structures is a matter of time and frequency of visits.

Shelter or complexity? Nile tilapia (Oreochromis niloticus) preference for enrichment structures is a matter of time and frequency of visits.