Duration Of Waiting Time Research Articles

A Study Comparing Waiting Times in Global and Local Queuing Systems with Heterogeneous Workers

A virtual marketplace or service-providing system must ensure minimal task response times. Varying working rates among the human workers in the system can lead to longer delays for certain tasks. The waiting time in the queue is crucially affected by the queueing architecture used in the system, whether global or local. Studies generally favor global queue systems over local ones, assuming similar processing rates. However, system behavior changes when workers are heterogeneous. In this research, we used simulation to compare the waiting times of tasks assigned to three categories of processing rates in both architectures and with various routing policies in local queues. We found that when using random tie-breaking, there was a correlation between waiting time duration and the proportion of tie-breaking events. Performance is improved when controlling these events using scheduling awareness of the workers’ processing rates. The global queue outperforms local queues when the workers are homogeneous. However, the push mechanisms that control the assignment processes and heterogeneity-aware algorithms improve local queue system waiting times and load balance. It is better than global queues when tasks are assigned to medium and fast workers, but it also enables specific slow workers’ assignments.

Benefit and harm of waiting time in liver transplantation for HCC.

Liver transplantation is the most successful treatment for limited-stage HCC. The waiting time for liver transplantation (LT) can be a critical factor affecting the oncological prognosis and outcome of patients with HCC. Efficient strategies to optimize waiting time are essential to maximize the benefits of LT and to reduce the harm of delay in transplantation. The ever-increasing demand for donor livers emphasizes the need to improve the organization of the waiting list for transplantation and to optimize organ availability for patients with and without HCC. Current progress in innovations to expand the donor pool includes the implementation of living donor LT and the use of grafts from extended donors. By expanding selection criteria, an increased number of patients are eligible for transplantation, which necessitates criteria to prevent futile transplantations. Thus, the selection criteria for LT have evolved to include not only tumor characteristics but biomarkers as well. Enhancing our understanding of HCC tumor biology through the analysis of subtypes and molecular genetics holds significant promise in advancing the personalized approach for patients. In this review, the effect of waiting time duration on outcome in patients with HCC enlisted for LT is discussed.

Machine Learning Approaches to Predict Patient’s Length of Stay in Emergency Department

As the COVID-19 pandemic has affected the globe, health systems worldwide have also been significantly affected. This pandemic has impacted many sectors, including health in the Kingdom of Jordan. Crises that put heavy pressure on the health systems’ shoulders include the emergency departments (ED), the most demanded hospital resources during normal conditions, and critical during crises. However, managing the health systems efficiently and achieving the best planning and allocation of their EDs’ resources becomes crucial to improve their capabilities to accommodate the crisis’s impact. Knowing critical factors affecting the patient length of stay prediction is critical to reducing the risks of prolonged waiting and clustering inside EDs. That is, by focusing on these factors and analyzing the effect of each. This research aims to determine the critical factors that predict the outcome: the length of stay, i.e., the predictor variables. Therefore, patients’ length of stay in EDs across waiting time duration is categorized as (low, medium, and high) using supervised machine learning (ML) approaches. Unsupervised algorithms have been applied to classify the patient’s length of stay in local EDs in the Kingdom of Jordan. The Arab Medical Centre Hospital is selected as a case study to justify the performance of the proposed ML model. Data that spans a time interval of 22 months, covering the period before and after COVID-19, is used to train the proposed feedforward network. The proposed model is compared with other ML approaches to justify its superiority. Also, comparative and correlation analyses are conducted on the considered attributes (inputs) to help classify the LOS and the patient’s length of stay in the ED. The best algorithms to be used are the trees such as the decision stump, REB tree, and Random Forest and the multilayer perceptron (with batch sizes of 50 and 0.001 learning rate) for this specific problem. Results showed better performance in terms of accuracy and easiness of implementation.

Dynamic data‐driven computation method for the number of waiting passengers and waiting time in the urban rail transit network

Excess passengers gathering on the urban rail transit platform in a short time brings huge security risks to passengers and the daily operation of urban rail transit. However, the real-time monitoring method of passenger flows, which relies on manual methods, cannot satisfy the requirement of daily operations at the network level anymore. This study proposes a dynamic data-driven computation and monitoring method for the number of waiting passengers on platforms to recognize the operational risk in real-time. For waiting passengers on platforms, the waiting time duration before boarding is also calculated based on a first-come-first-service basis. It can be used to provide real-time information services to passengers and evaluate service quality. Moreover, the proposed methodology relies solely on the AFC data and the train timetable, which makes it easy to implement in the daily operation of any urban rail transit system. Finally, taking the Beijing rail transit network as a case study, the real-time number of waiting passengers on each platform, and the time duration passengers should wait before boarding are calculated dynamically. Meanwhile, the spatio-temporal distribution of passengers’ waiting time and waiting passengers are detailly analyzed based on the method of cluster analysis and the complex network theory.

The Influence of Avatar Embodiment on Time Perception - Towards VR for Time-Based Therapy

Psycho-pathological conditions, such as depression or schizophrenia, are often accompanied by a distorted perception of time. People suffering from this conditions often report that the passage of time slows down considerably and that they are “stuck in time.” Virtual Reality (VR) could potentially help to diagnose and maybe treat such mental conditions. However, the conditions in which a VR simulation could correctly diagnose a time perception deviation are still unknown. In this paper, we present an experiment investigating the difference in time experience with and without a virtual body in VR, also known as avatar. The process of substituting a person’s body with a virtual body is called avatar embodiment. Numerous studies demonstrated interesting perceptual, emotional, behavioral, and psychological effects caused by avatar embodiment. However, the relations between time perception and avatar embodiment are still unclear. Whether or not the presence or absence of an avatar is already influencing time perception is still open to question. Therefore, we conducted abetween-subjectsdesign with and without avatar embodiment as well as a real condition (avatarvs.no-avatarvs.real). A group of 105 healthy subjects had to wait for seven and a half minutes in a room without any distractors (e.g., no window, magazine, people, decoration) or time indicators (e.g., clocks, sunlight). The virtual environment replicates the real physical environment. Participants were unaware that they will be asked to estimate their waiting time duration as well as describing their experience of the passage of time at a later stage. Our main finding shows that the presence of an avatar is leading to a significantly faster perceived passage of time. It seems to be promising to integrate avatar embodiment in future VR time-based therapy applications as they potentially could modulate a user’s perception of the passage of time. We also found no significant difference in time perception between therealand the VR conditions (avatar,no-avatar), but further research is needed to better understand this outcome.

TEACHING A CHILD WITH AUTISM SPECTRUM DISORDERS TO TOLERATE DELAYED REINFORCEMENT

It is necessary to teach children with autism spectrum disorders (ASD) delayed reinforcement skills. The aim of the present case study was to examine the effectiveness of shaping procedure application in order to increase appropriate wait time with a six year old boy diagnosed with ASD. In this study we applied delayed reinforcement protocol, which is based on the shaping procedure. The procedure was applied during discrete trial training, natural environment teaching and in home environment by parents. Baseline data was collected regarding adequate wait time exhibited by a participant in three different sessions, where it was established that average wait time duration was four seconds. In eleven sessions, the child mastered the desired skill. A significant progress was related to the application of the protocol in home environment by the parents and the autonomous use of behavior self-regulation strategies. It is relevant to mention that the alternative activities delivered during the time delay were considered as neutral stimuli and after the application of this protocol, they have become preferred items. We believe that this case studies’ biggest limitation is the need for applying this procedure at all in the context of preparing the child for taking on the desired passive role at school.
 
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Economic Order Quantity Model with Weibull Distributed Deterioration under a Mixed Cash and Prepayment Scheme

Two distinct inventory models are investigated for a deteriorating item under the frequency of advertisement and market price-sensitive aggregate demand where the deterioration percentage complies with Weibull distribution. In one model, the stock-out environment is not studied, while another one handles the stock-out situation by moderately backordering based upon the waiting time duration for the products. Advance payment, another realistic feature, is implemented by paying off a fraction of the acquisition cost amid single or many equal segments from the order placing moment to receiving moment whereas the remaining fraction is accomplished at the order delivery instant by the practitioner to the supplier. The utmost aim is computing the inventory policy along with the market price and marketing strategy to reach the highest total profit for both models. The models formulated here extend several inventory studies previously developed in the literature and suggest several important outcomes. This makes two exceedingly nonlinear and mixed-integer optimization problems, which are elucidated by constructing two efficacious algorithms. Two numerical illustrations are accomplished to perceive the working competence of the algorithms and the consequences of the parameters on the practitioner's optimal policy are highlighted in a tabular form executing a sensitivity examination. Based on the performed analyses, finally, some decision-making salient findings are obtained.

Infection Prevention and Control Strategies for the Peri-Operative Period of Emergency Surgery during the Coronavirus Disease 2019 Outbreak in a Neurosurgery Department in Wuhan, China.

Objective: In December 2019, a novel coronavirus infectious disease, coronavirus disease 2019 (COVID-19), began to appear in China. Wuhan, Hubei Province, is the origin and core location of the epidemic. Neurosurgeons were faced with the challenge of balancing treatment of patients with life-threatening conditions and preventing the cross-transmission of the virus. Methods: A series of infection prevention and control strategies was adopted for the peri-operative period of emergency surgeries in our department. These strategies include protective measures for the emergency department (ED) and measures for the peri-operative period of emergency surgery. The propensity score matching (PSM) was used to match COVID-19-related patients with patients before the epidemic. Length of wait time in the ED and duration of operation were compared. Results: From January 23, 2020 to March 18, 2020, we performed emergency surgery for 19 patients who were either COVID-19-related or COVID-19-suspected. None of the medical staff involved in the surgeries developed viral infection, and no peri-operative virus transmission occurred in our hospital. After the PSM, 32 patients were included in the epidemic group and the pre-epidemic group (16 patients in each group). The duration of wait time in the ED of the former group was longer than that of the latter group (z = -3.000; p = 0.003). During the epidemic, the duration of a craniotomy was longer than before the epidemic (z = -2.253; p = 0.024), and there was no difference in the duration of interventional surgery (z = -0.314; p = 0.753). Conclusion: We believe that our experience can provide a useful reference for other surgeons facing the same challenges and as a lesson for similar infectious diseases that may occur in the future.

Characteristics and Outcomes of Patients Discharged Directly Home From a Medical Intensive Care Unit: A Retrospective Cohort Study.

To evaluate the safety of directly discharging patients home from the medical intensive care unit (MICU). Single-center retrospective observational study of consecutive MICU direct discharges to home from an urban university hospital between June, 1, 2017, and June 30, 2019. Of 1061 MICU discharges, 331 (31.2%) patients were eligible for analysis. Patients were divided into 2 groups based on duration of wait-time (< or ≥24 hours) between ward transfer order and ultimate hospital discharge. Most patients (68.2%) were discharged in <24 hours. Patients who waited for a floor bed for ≥24 hours prior to discharge had longer hospital length-of-stay (LOS, median 3.83 versus 2.00 days) and ICU LOS (median 3.51 versus 1.74 days). Overall, 44 (13.3%) direct MICU discharges were readmitted to the hospital within 30-days, but there was no difference in this outcome or in 30-day mortality when comparing the 2 wait-time groups. The practice of directly discharging MICU patients home does not negatively influence patient outcomes. Patients who overstay in the ICU after being deemed transfer-ready are unlikely to be benefiting from critical care, but impact hospital throughput and resource utilization. Prospective investigation into this practice may provide further confirmation of its feasibility and safety.

ANALISIS WAKTU TUNGGU PELAYANAN RADIOLOGI DI RUMAH SAKIT SYARIF HIDAYATULLAH TAHUN 2018

Radiology services as integrated parts of health services as a whole are part of the community's need for health services. Therefore, the radiology services should provide quality services. The study was a descriptive analytic research with qualitative and quantitative approaches or mix method that used data collection in the form of waiting time duration for radiology services, in-depth interviews, observation, and document review. Sampling using proposition estimation with random sampling technique with the number of 106 patients. The informants in primary data collection at the Radiology Installation at Syarif Hidayatullah Hospital were the head of the radiology installation, radiology specialist, head of the radiology and radiographers unit.The average waiting time duration for radiology services is 4 hours 59 minutes. The result has not met Kepmenkes Standard No.129/Menkes/SK/II/2008, which is ? 3 hours. The standard of waiting time duration for radiology service is not met the rule regarding to there is no doctor who is the standby or full timer while the radiology service to the patient is given for 24 hours.It is expected that Syarif Hidayatullah Hospital has teleradiology which can be used as a solution to meet the waiting time duration for radiology services, especially the reading of photos and expenditure of expedition results and can meet the quality of services that appropriate to the standards. Keywords: waiting time duration, radiology services

Determinants of focused antenatal care service satisfaction in public health facilities in Ethiopia 2018: A mixed study design

Ethiopia has been implementing focused antenatal care package to reduce maternal and child deaths. The quality of antenatal care service has not being resolved widely due to unstandardized measurement. Hence, this study assessed determinants of focused antenatal care service satisfaction in Public Health Facilities of West Guji Zone, Ethiopia, 2018. A facility based cross-sectional triangulated with qualitative study design was conducted and multistage sampling techniques was used to select 810 pregnant women in West Guji Zone, from February 5th to 28th, 2018. Key informants were selected purposively for in-depth interview. Internal reliability test checked and Crobach‘s alpha became 86.5%. Data was cleaned, coded, entered to EPI INFO software, and then exported to SPSS version 21 for analysis. Predictors in multivariate logistic regression analysis determined where p value is less than 0.05. Qualitative data were thematically analyzed and triangulated for final conclusion. The overall prevalence of satisfaction was 66%. The predictors of overall satisfaction level were urban resident (AOR=1.91, 95%CI: 1.07-3.35), males’ sex service provider (AOR=0.42, 95%CI: 0.31-0.70), housewife in occupation (AOR=5.81, 95%CI :1.06-31.35), living alone (AOR= 0.16, 95%CI: 0.04-0.71), waiting time 30-60 minutes (AOR= 0.62, 95%CI :0.40-0.99), frequency ANC (AOR= 0.35, 95%CI: 0.16-0.76), care giving approach (AOR= 5.10, 95%CI: 2.10-12.51), and service provider respect (AOR= 2.41, 95%CI: 1.31-4.50). Three-in-ten study women were dissatisfied with the service they received and predicators were rural residence, male service providers, government employees, living alone, 30-60’ waiting time duration, frequency of antenatal care visit, care giving and respectful approach of service provider. Therefore, a multidimensional intervention is crucial to alleviate multifaceted negative outcomes in maternal health. Key words: Antenatal care, child, maternal satisfaction.

Wait Times in Musculoskeletal Patients: What Contributes to Patient Satisfaction.

Introduction:The purpose of this study was to determine how wait time duration is associated with patient satisfaction and how appointment characteristics relate to wait time duration and patient satisfaction in the orthopedic surgery clinic.Methods:Two hundred sixty-four patients visiting one of 3 ambulatory orthopedic surgery clinics were asked to estimate their wait time and to rate their satisfaction with the visit. The associations between appointment characteristics, wait time, and satisfaction were analyzed using t tests, 1-way analysis of variance, and Pearson correlation coefficients.Results:Wait times were significantly different based on visit type, appointment time, whether an X-ray was required, and whether a trainee was involved (P < .001). Patients with wait times less than 30 minutes had higher satisfaction scores (P < .001). Satisfaction ratings were significantly different based on the surgeon’s management recommendation (P = .0211), but were not significantly different based on sex, age, office location, visit type, appointment time subsection, or time spent with the physician (P > .05).Conclusion:Wait times negatively correlated with satisfaction. New patient visits, appointment times in the later third of the day, appointments requiring an X-ray, and appointments involving a trainee had significantly longer wait times. Care should be taken to inform patients with visits involving these characteristics that they may experience longer than average wait times.

MON-199 KIDNEY TRANSPLANTATION IN MULTIPLE MYELOMA: CASE REPORTS

Renal transplantation is traditionally contraindicated in Multiple Myeloma (MM) due to increased risk of post-transplant disease recurrence and associated complications. However, with recent advances in MM treatment modalities and overall survival, renal transplant centers are reporting increasing success in carefully selected groups of patients with treated plasma cell dyscrasias. We hereby present our experience through 3 case reports. A 72-year-old Caucasian male with IgG smoldering MM, and end stage diabetic nephropathy, received prophylactic Bortezomib chemotherapy for high lambda light chain burden, 6 months prior to an ABO incompatible living related kidney transplant in 2015. A stable renal function and ongoing hematological remission without further maintenance therapy was achieved for the next 24 months. MM progression in the form of gastrointestinal amyloidosis and plasma cell infiltration of his renal allograft was diagnosed 2 years post transplant. This was successfully mitigated with further cycles of Bortezomib containing chemotherapy, stabilizing his serum creatinine around 180umol/L. A 68-year-old Caucasian male, with stage 3 lambda light chain MM and end stage cast nephropathy was evaluated for renal transplantation. Hematological remission was achieved through Bortezomib based induction and subsequent autologous stem cell transplant, with thalidomide maintenance therapy. Unfortunately, no suitable living related donor was available, and he received a cadaveric renal transplant 2.5 years later in 2017. 10 months post transplant, he was diagnosed with CMV pneumonitis, and required CMV immunoglobulin therapy as a consequence of residue hypogammaglobulinemia secondary to his MM. His renal function has remained stable post transplant with a baseline serum creatinine of 120umol/L. A 49-year-old Greek female, with end stage cast nephropathy secondary to stage 3 kappa light chain MM. Remission of her myeloma was achieved through Bortezomib containing induction therapy followed by an autologous stem cell transplant. She subsequently underwent a successful ABO incompatible living related kidney transplant 10 months later in 2018. Her allograft function has remained stable with a serum creatinine of 90umol/L. Sustained renal allograft function can be achieved in MM patients with hematological remission, improving quality of life off dialysis whilst broadening myeloma treatment options previously limited by end stage renal failure. Logistically, living related donors provide a favorable option, significantly reducing the duration of wait time and risk of further deterioration. Unique complications associated with underlying MM, in the form of disease recurrence or increased predisposition to opportunistic infections can occur post renal transplant. However, early recognition and mitigation will ensure perseverance of allograft function.

Superior Outcomes and Reduced Wait Times in Pediatric Recipients of Living Donor Liver Transplantation.

Living donor liver transplantation (LDLT) is increasingly used to bridge the gap between the current supply and demand imbalance for deceased donor organs to provide lifesaving liver transplantation. Outcomes of 135 children who underwent LDLT were compared with 158 recipients of deceased donor liver transplantation (DDLT) at the largest pediatric liver transplant program in Canada. Recipients of LDLT were significantly younger than deceased donor recipients (P ≤ 0.001), less likely to require dialysis pretransplant (P < 0.002) and had shorter wait time duration when the primary indication was cholestatic liver disease (P = 0.003). The LDLT donors were either related genetically or emotionally (79%), or unrelated (21%) to the pediatric recipients. One-, 5-, and 10-year patient survival rates were significantly higher in LDLT (97%, 94%, and 94%) compared with DDLT (92%, 87%, and 80%; log-rank P = 0.02) recipients, as were graft survival rates (96%, 93%, and 93% for LDLT versus 89%, 81.4%, and 70%, respectively, for DDLT; log-rank P = 0.001). Medical and surgical complications were not statistically different between groups. Graft failure was higher in recipients of DDLT (odds ratio, 2.60; 95% confidence interval, 1.02, 6.58) than in the LDLT group after adjustment for clinical characteristics and propensity score. Living donor liver transplantation provides superior outcomes for children and is an excellent and effective strategy to increase the chances of receiving a liver transplant.

Delayed access to bunion correction surgery

Category: Bunion Introduction/Purpose: Little is known about the effect of delayed access to bunion correction (Hallux Valgus) surgery on patient-reported outcomes. The objective of this study is to measure the association between delayed access to bunion correction surgery and post-operative patient-reported outcomes. Methods: This study prospectively recruited patients to complete pre-operative patient-reported outcomes measuring pain, depression and foot and ankle health. Patients complete the same patient-reported outcomes six months post-operatively. Linear regression models measured outcomes, adjusting for baseline health, age category, sex, comorbidities and socio-economic status. Results: This study included 74 participants, a response rate of 53% among eligible patients. Among participants, 58.9% underwent a Lapidus procedure, the remainder underwent a corrective osteotomy. There was no relationship between post-operative depression and pain scores with duration of wait time, adjusting for patient characteristics. Longer waits for bunion correction surgery, adjusting for other factors, were associated with smaller gains in health in four of the five domains of measurement of foot and ankle health. Conclusion: At the six-month post-operative time point, prolonged wait times were detrimental to foot and ankle outcomes in four of the five domains of the foot and ankle specific PRO. Policies for expediting access for symptomatic hallux valgus are warranted to mitigate poorer long-term outcomes.

Quantifying Patient-Reported Disability and Health While Waiting for Bunion Surgery.

Many patients with hallux valgus progress to experiencing pain and loss of function that requires corrective surgery when nonoperative treatments fail. The primary goal of this study was to measure changes in participants' health while patients waited for their operative correction. Patients were prospectively recruited to complete a number of patient-reported outcome measures preoperatively. Baseline data collection was initiated in October 2014, and participants' second surveys were returned by August 2017. The setting of the study was Vancouver, Canada. There were 80 participants in the study. The participation rate among eligible patients was 52.7%. The average wait time for surgery exceeded 8 months, with a mean wait of 35.7 weeks. Baseline pain among participants was high. Only in the domain of foot- and ankle-related quality of life was the duration of wait time associated with participants' change in health. The other 4 domains of foot function remained stable over the preoperative period. Preoperative health in this study was consistent with other research showing high pain and compromised foot function among patients failing nonoperative therapies for treatment of hallux valgus. This study found high pain and compromised foot function among patients waiting for hallux valgus surgery but only minor relationships between participants' duration of wait time for operative correction of the first metatarsophalangeal joint and changes in patient-reported outcome scores. Level III, comparative study.

The Online Waiting Experience: Using Temporal Information and Distractors to Make Online Waits Feel Shorter

Research on how to manage the online waiting experience has begun to emerge but has primarily focused on the use of distracting cues for online wait management (e.g., text and images that distract the user from the wait). The use of temporal information in waiting webpages (e.g., text and images that convey the duration of the wait) has received little attention from the information systems literature, and we have limited understanding about how the two types of cues (temporal information and distractors) affect wait time estimation. We address this gap by developing a theoretical model of how these cues affect the waiting experience and perceived waiting time. We tested the model with a 2 x 2 x 2 x 2 controlled lab experiment and 1025 participants using progress bar treatments that included temporal information (spatial and text description of the wait time duration) and distractors (progress bar animation and accelerated filling of the progress bar) with both short and long wait conditions. We found that the two types of cues reduced perceived waiting time through different nomological paths. Temporal cues reduced perceived uncertainty about the wait, while distractor cues directed attention away from the wait, increasing perceived enjoyment and wait time distortion. Further, the enhanced waiting experience reduced the perceived waiting time. Further, these cues were effective in managing the online waiting experience with both short and long waits.

Single-dose intra-arterial neoadjuvant chemotherapy while waiting for radical hysterectomy for stage IB-IIB cervical cancer.

Extended wait time prior to initial surgery may increase patients' anxiety. Therefore, patients may opt to receive other available treatments to inhibit tumor growth until surgery. This retrospective study describes our experience with single-dose intra-arterial neoadjuvant chemotherapy (IANAC) to more effectively utilize the wait time prior to radical hysterectomy. A total of 12 patients with International Federation of Gynecology and Obstetrics stage IB1-IIB cervical cancer were treated with single-dose IANAC prior to radical hysterectomy. Cisplatin and paclitaxel were administered intra-arterially or intravenously, respectively. The surgical outcome, prognosis and factors affecting disease recurrence were compared between these 12 patients and 57 patients in a primary surgery alone (PS) control group. As regards surgical outcome, there were no significant differences between the two groups. During the postoperative follow-up period (median, 41 months), disease recurrence was observed in 5/12 (41.6%) IANAC cases and in 22/57 (38.5%) PS cases (median follow-up, 54 months). There was no significant difference in disease-free survival (DFS) or 3-year survival rates between IANAC and PS (91.6 vs. 71.9%, respectively). The multivariate analysis demonstrated that wait time duration (≥45 vs. <45 days) and the use of IANAC did not affect DFS. Only tumor histology (squamous vs. non-squamous) was found to be an independent prognostic factor for DFS (hazard ratio = 0.35, 95% confidence inerval: 0.145-0.8967, P=0.0292). In addition, distal recurrence was statistically more frequent in the IANAC group compared with that in the PS group (P=0.0405). Therefore, single-cycle IANAC should not be performed without careful consideration.

41 * Electrical cardioversion of atrial fibrillation with the novel oral anticoagulants: a single centre UK-based registry experience

Background: Oral anticoagulation is mandatory in patients undergoing electrical cardioversion (ECV) for atrial fibrillation (AF) to help negate the potential stroke risk. Independent prospective data concerning safety, procedural outcome and impact on procedural waiting times using novel oral anticoagulant (NOAC) treatment in ECV is limited. Methods: Analysis of all consecutive patients undergoing electrical cardioversion (ECV) between January 2013 and March 2014 was performed. Data on baseline demographics, waiting times for cardioversion, cancellations, procedural success and complications were collected. Results: A total of 229 procedures were performed during this period; 122 were anticoagulated with a NOAC (Rivaroxaban 120, Dabigatran 2, and mean age 63±12, female 31%) and 107 with Warfarin (mean age 67±10, female 41%). The mean CHA2DS2Vasc score was 2.4±1.5 versus 2.7±1.4 respectively for NOAC vs Warfarin (p=0.22). Similar corresponding mean HAS-BLED scores were observed in both groups 1.5±0.8 and 1.6±0.7 for NOAC vs Warfarin (p=0.13). No major bleeding episodes, stroke, thromboembolic events or death occurred in either group. There were significantly less cancellations in the Rivaroxaban group, 1 patient (0.8%) due to dose omission of Rivaroxaban versus 11 patients (10.3%) in the warfarin group due to sub therapeutic INRs on the day of the procedure (p=0.004). Shorter mean procedural waiting time duration was observed in the NOAC group in comparison to warfarin group (mean±SD=67±49 versus 95±66 days, p=0.006). A trend towards greater procedural success was observed in the NOAC group 94% (115/122) compared to Warfarin, 79% (85/107 p=0.001). Conclusions: This single centre experience of cardioversion with the NOACs demonstrates that the procedure is safe and effective. Cardioversion is performed in a more timely fashion, with very few cancellations and shorter waiting time, which may impact upon a greater long-term maintenance of sinus rhythm. ![Graphic][1] [1]: /embed/inline-graphic-1.gif

A semi‐Markov model to assess reliably survival patterns from birth to death in free‐ranging populations

Summary 1. Semi‐Markov models explicitly define the distribution of waiting time duration and have been used as a convenient framework for modelling the time spent in one physiological state in previous biological studies. 2. Here, we focus on the modelling of the time spent within a life‐cycle stage (e.g. juvenile, adult and old) by individuals over their lifetime from Capture–Mark–Recapture data, which are commonly used to estimate demographic parameters in free‐ranging populations. 3. We propose a parametric model (1) with a semi‐Markov state, (2) associated to a hazard function and (3) accounting for imperfect detection to assess reliably survival patterns from birth to death. 4. These models indeed outperform models with a linear trend or a quadratic form, often selected as the best model for survival in capture–recapture studies. 5. Moreover, our approach offers the first opportunity to estimate statistically rather than visually the age of the onset of actuarial senescence, associated with confidence intervals. 6. The application of this new approach to the detailed long‐term study of survival in roe deer at Trois Fontaines (France) illustrates the relevance of semi‐Markov models to assess survival patterns from birth to death.