System Implications of the Ambulance Arrival-to-Patient Contact Interval on Response Interval Compliance

1994 ◽  
Vol 9 (4) ◽  
pp. 230-232 ◽  
Author(s):  
Jack P. Campbell ◽  
Matthew C. Gratton ◽  
Joseph A. Salomone ◽  
Daniel J. Lindholm ◽  
William A. Watson
Keyword(s):  
Response Time ◽  
Statistical Significance ◽  
Public Utility ◽  
Third Party ◽  
Measuring System ◽  
System Response ◽  
Time Interval ◽  
Patient Access ◽  
Time Intervals ◽  
Chi Square

AbstractBackground:Background: In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined.Purpose:To determine the effect of the VSPA interval on the mandated code 1 (<9 min) and code 2 (<13 min) response time interval compliance in an urban, public-utility model system.Methods:A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the man dated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance.Results:Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p<0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012).Conclusion:The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.

Epidemiology of Syphilis in Hungary between 1952 and 1996

2000 ◽  
Vol 11 (5) ◽  
pp. 327-333 ◽  
Author(s):  
Viktória Várkonyi ◽  
Timea Tisza ◽  
Attila Horváth ◽  
Teréz Takácsy ◽  
Margit Berecz ◽  
...  
Keyword(s):  
Linear Regression ◽  
Time Interval ◽  
Time Intervals ◽  
Chi Square ◽  
The Public ◽  
Incidence Trends ◽  
Regression Test ◽  
Chi Square Test ◽  
Therapeutic Measures ◽  
Chi Square Analysis

Trends in morbidity from syphilis in Hungary between 1952 and 1996 were analysed. The incidence of syphilis/100,000 inhabitants declined rapidly owing to the public health and therapeutic measures of the early 1950s (1952: total=73.6, early infections=60.2; 1962: total=13.7, early infections=8.7). After a temporary, slight increase until 1973 the number of reported syphilis cases declined continuously between 1978 and 1989 (1989: total=0.9, early infections=0.84). In 1994 a marked increase occurred when compared with 1993 (1993: total=early: 1.4. 1994: total=2.3, early infections=2.2). Incidence trends were statistically analysed using Chi-square test and linear regression. Chi-square analysis showed that the changes in the incidence of total and early syphilis are significant ( p<0.00001) comparing the time intervals 1952–1962 with 1962–1966 and 1975–1979 with 1988–1992. The same trends were found using the linear regression test, except for the time interval of 1960–1973.

scholarly journals In Vivo Biocompatibility, Mechanical, and Antibacterial Properties of Cements Modified with Propolis in Different Concentrations

2020 ◽  
Vol 14 (01) ◽  
pp. 077-084 ◽  
Author(s):  
Izaura Helena Chaves de Meneses ◽  
Gêisa Aiane de Morais Sampaio ◽  
Fabiola Galbiatti de Carvalho ◽  
Hugo Lemes Carlo ◽  
Eliseu Aldrighi Münchow ◽  
...  
Keyword(s):  
Antibacterial Property ◽  
Statistical Significance ◽  
Randomized Study ◽  
Antibacterial Properties ◽  
Optical Microscope ◽  
Time Interval ◽  
Time Intervals ◽  
Agar Diffusion Test ◽  
Significant Difference

Abstract Objectives The focus of this triple-blind randomized study was to evaluate the mechanical properties, antibacterial effect, and in vivo biocompatibility of glass ionomer cements (GICs) modified with ethanolic extracts of propolis (EEP). Materials and Methods For biocompatibility tests, 135 male Wistar rats were used and divided into nine groups: Group C (control, polyethylene), Groups M, M10, M25, M50 (Meron; conventional, and modified with 10%, 25%, 50% EEP, respectively), Groups KC, KC10, KC25, KC50 (Ketac Cem; conventional, and modified with 10%, 25%, 50% EEP, respectively). The tissues were analyzed under an optical microscope for different cellular events in different time intervals. Shear bond strength test (SBST) on cementation of metal matrices (n = 10, per group), adhesive remnant index (ARI) in bovine incisors (n = 10, per group), and antibacterial properties by the agar diffusion test (n = 15, per group) were analyzed. Statistical Analysis Data were analyzed by Kruskal–Wallis test followed by Dunn, and one-way analysis of variance test followed by Tukey’s test (p < 0.5). Results Morphological evaluation demonstrated intense inflammatory infiltrate in Groups M10 and KC10 in the time intervals of 7 (p = 0.001) and 15 (p = 0.006) days. Multinucleated giant cells were shown to be more present in Group M1, with statistical difference from Control and KC50 Groups in the time interval of 7 days (p = 0.033). The SBST showed no statistical significance among the groups (p > 0.05). Antibacterial property showed a statistically significant difference between Meron and Meron 50%-EEP Groups, and between Ketac and Ketac 50%-EPP Groups (p = 0.001). Conclusions The intensity of histological changes resulting from the cements was shown to be inversely proportional to the concentration of propolis added; Ketac 50%-EPP was the concentration that had the most favorable biocompatibility results. Addition of EEP to GIC did not negatively change the SBST and ARI. Antibacterial property demonstrated a concentration-dependent effect.

METABOLIC STUDIES WITH 131I-LABELED THYROXINE. II.

1963 ◽  
Vol 44 (3) ◽  
pp. 475-480 ◽  
Author(s):  
R. Grinberg
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Optic Nerve ◽  
Pituitary Gland ◽  
Time Interval ◽  
Time Intervals ◽  
Pituitary Glands ◽  
The Central Nervous System ◽  
Tentative Explanation

ABSTRACT Radiologically thyroidectomized female Swiss mice were injected intraperitoneally with 131I-labeled thyroxine (T4*), and were studied at time intervals of 30 minutes and 4, 28, 48 and 72 hours after injection, 10 mice for each time interval. The organs of the central nervous system and the pituitary glands were chromatographed, and likewise serum from the same animal. The chromatographic studies revealed a compound with the same mobility as 131I-labeled triiodothyronine in the organs of the CNS and in the pituitary gland, but this compound was not present in the serum. In most of the chromatographic studies, the peaks for I, T4 and T3 coincided with those for the standards. In several instances, however, such an exact coincidence was lacking. A tentative explanation for the presence of T3* in the pituitary gland following the injection of T4* is a deiodinating system in the pituitary gland or else the capacity of the pituitary gland to concentrate T3* formed in other organs. The presence of T3* is apparently a characteristic of most of the CNS (brain, midbrain, medulla and spinal cord); but in the case of the optic nerve, the compound is not present under the conditions of this study.

Use of SAMe-TT₂R₂ Score to Predict the Quality of Anticoagulation Control in Patients with Atrial Fibrillation Receiving Warfarin in Thailand

2020 ◽  
Vol 103 (6) ◽  
pp. 548-552
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Statistical Significance ◽  
Discrimination Performance ◽  
Poor Quality ◽  
Chi Square ◽  
Exact Test ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR

Predictors of Faster Decline of Residual Renal Function in Taiwanese Peritoneal Dialysis Patients

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 191-195 ◽  
Author(s):  
Chia-Te Liao ◽  
Chih-Chung Shiao ◽  
Jenq-Wen Huang ◽  
Kuan-Yu Hung ◽  
Hsueh-Fang Chuang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Clinical Laboratory ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Residual Renal Function ◽  
Measure Data ◽  
Chi Square ◽  
Artery Disease

⋄ Objective Loss of residual renal function (RRF) in peritoneal dialysis (PD) patients is a powerful predictor of mortality. The present study was conducted to determine the predictors of faster decline of RRF in PD patients in Taiwan. ⋄ Methods The study enrolled 270 patients starting PD between January 1996 and December 2005 in a single hospital in Taiwan. We calculated RRF as the mean of the sum of 24-hour urea and creatinine clearance. The slope of the decline of residual glomerular filtration rate (GFR) was the main outcome measure. Data on demographic, clinical, laboratory, and treatment parameters; episodes of peritonitis; and hypotensive events were analyzed by Student t-test, Mann–Whitney U-test, and chi-square, as appropriate. All variables with statistical significance were included in a multivariate linear regression model to select the best predictors ( p < 0.05) for faster decline of residual GFR. ⋄ Results All patients commencing PD during the study period were followed for 39.4 ± 24.0 months (median: 35.5 months). The average annual rate of decline of residual GFR was 1.377 ± 1.47 mL/min/m2. On multivariate analysis, presence of diabetes mellitus ( p < 0.001), higher baseline residual GFR ( p < 0.001), hypotensive events ( p = 0.001), use of diuretics ( p = 0.002), and episodes of peritonitis ( p = 0.043) independently predicted faster decline of residual GFR. Male sex, old age, larger body mass index, and presence of coronary artery disease or congestive heart failure were also risk factors on univariate analysis. ⋄ Conclusions Our results suggested that diabetes mellitus, higher baseline residual GFR, hypotensive events, and use of diuretics are independently associated with faster decline of residual GFR in PD patients in Taiwan.

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

scholarly journals Neural Network Approach for Global Solar Irradiance Prediction at Extremely Short-Time-Intervals Using Particle Swarm Optimization Algorithm

Energies ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 1213
Author(s):  
Ahmed Aljanad ◽  
Nadia M. L. Tan ◽  
Vassilios G. Agelidis ◽  
Hussain Shareef
Keyword(s):  
Neural Networks ◽  
Particle Swarm Optimization ◽  
Solar Irradiance ◽  
Particle Swarm ◽  
Time Interval ◽  
Time Intervals ◽  
Swarm Optimization ◽  
Backpropagation Neural Networks ◽  
Proposed Model ◽  
Short Time

Hourly global solar irradiance (GSR) data are required for sizing, planning, and modeling of solar photovoltaic farms. However, operating and controlling such farms exposed to varying environmental conditions, such as fast passing clouds, necessitates GSR data to be available for very short time intervals. Classical backpropagation neural networks do not perform satisfactorily when predicting parameters within short intervals. This paper proposes a hybrid backpropagation neural networks based on particle swarm optimization. The particle swarm algorithm is used as an optimization algorithm within the backpropagation neural networks to optimize the number of hidden layers and neurons used and its learning rate. The proposed model can be used as a reliable model in predicting changes in the solar irradiance during short time interval in tropical regions such as Malaysia and other regions. Actual global solar irradiance data of 5-s and 1-min intervals, recorded by weather stations, are applied to train and test the proposed algorithm. Moreover, to ensure the adaptability and robustness of the proposed technique, two different cases are evaluated using 1-day and 3-days profiles, for two different time intervals of 1-min and 5-s each. A set of statistical error indices have been introduced to evaluate the performance of the proposed algorithm. From the results obtained, the 3-days profile’s performance evaluation of the BPNN-PSO are 1.7078 of RMSE, 0.7537 of MAE, 0.0292 of MSE, and 31.4348 of MAPE (%), at 5-s time interval, where the obtained results of 1-min interval are 0.6566 of RMSE, 0.2754 of MAE, 0.0043 of MSE, and 1.4732 of MAPE (%). The results revealed that proposed model outperformed the standalone backpropagation neural networks method in predicting global solar irradiance values for extremely short-time intervals. In addition to that, the proposed model exhibited high level of predictability compared to other existing models.

Real-World Experience with Artificial Intelligence-Based Triage in Transferred Large Vessel Occlusion Stroke Patients

2021 ◽  
pp. 1-6
Author(s):  
Jacob R. Morey ◽  
Xiangnan Zhang ◽  
Kurt A. Yaeger ◽  
Emily Fiano ◽  
Naoum Fares Marayati ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Clinical Outcomes ◽  
Warning System ◽  
Large Vessel ◽  
Time Interval ◽  
Large Vessel Occlusion ◽  
Time Intervals ◽  
Vessel Occlusion ◽  
Left Behind ◽  
Stroke Center

<b><i>Background and Purpose:</i></b> Randomized controlled trials have demonstrated the importance of time to endovascular therapy (EVT) in clinical outcomes in large vessel occlusion (LVO) acute ischemic stroke. Delays to treatment are particularly prevalent when patients require a transfer from hospitals without EVT capability onsite. A computer-aided triage system, Viz LVO, has the potential to streamline workflows. This platform includes an image viewer, a communication system, and an artificial intelligence (AI) algorithm that automatically identifies suspected LVO strokes on CTA imaging and rapidly triggers alerts. We hypothesize that the Viz application will decrease time-to-treatment, leading to improved clinical outcomes. <b><i>Methods:</i></b> A retrospective analysis of a prospectively maintained database was assessed for patients who presented to a stroke center currently utilizing Viz LVO and underwent EVT following transfer for LVO stroke between July 2018 and March 2020. Time intervals and clinical outcomes were compared for 55 patients divided into pre- and post-Viz cohorts. <b><i>Results:</i></b> The median initial door-to-neuroendovascular team (NT) notification time interval was significantly faster (25.0 min [IQR = 12.0] vs. 40.0 min [IQR = 61.0]; <i>p</i> = 0.01) with less variation (<i>p</i> &#x3c; 0.05) following Viz LVO implementation. The median initial door-to-skin puncture time interval was 25 min shorter in the post-Viz cohort, although this was not statistically significant (<i>p</i> = 0.15). <b><i>Conclusions:</i></b> Preliminary results have shown that Viz LVO implementation is associated with earlier, more consistent NT notification times. This application can serve as an early warning system and a failsafe to ensure that no LVO is left behind.

scholarly journals Social determinants of telemedicine utilization in ambulatory cardiovascular patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Kemar J Brown ◽  
Njambi Mathenge ◽  
Daniela Crousillat ◽  
Jaclyn Pagliaro ◽  
Connor Grady ◽  
...  
Keyword(s):  
Statistical Significance ◽  
The Elderly ◽  
P Value ◽  
Chi Square ◽  
Cardiovascular Patients ◽  
Baseline Characteristics ◽  
Racial Ethnic ◽  
Cardiovascular Care ◽  
Zip Code ◽  
Hispanic White

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in the rapid uptake of telemedicine (TM) for routine cardiovascular care. Objectives To examine the predictors of TM utilization among ambulatory cardiology patients during the COVID-19 pandemic. Methods In this single centre retrospective study, all ambulatory cardiovascular encounters occurring between March 16th - June 19th, 2020 were assessed. Baseline characteristics by visit type (in-person, TM-phone, TM-video) were compared using Chi-square and student t-tests, with statistical significance defined by p value &lt; 0.05. Multivariate logistic regression was used to explore the predictors of TM versus in-person care. Results 8446 patients (86% Non-Hispanic White, 42% female, median age 66.8 +/- 15.2 years) completed an ambulatory cardiovascular visit during the study period. TM-phone (n = 4,981, 61.5%) was the primary mode of ambulatory care followed by TM-video (n = 2693, 33.2%). Non-Hispanic Black race (OR 0.56; 95% CI: 0.35 - 0.94, p-value=0.02), Hispanic ethnicity (OR 0.53; 95% CI: 0.29 - 0.98, p = 0.04), public insurance (Medicaid OR 0.50; 95% CI:0.32 – 0.79, p = 0.003, Medicare OR 0.65; 95% CI: 0.47– 0.89, p = 0.009), zip-code linked median household income (MHI) of &lt;$75,000, age &gt;85 years, and patients with a diagnosis of heart failure were associated with reduced access to TM-video encounters and a higher likelihood of in-person care. Conclusions Significant disparities in TM-video access for ambulatory cardiovascular care exist among the elderly, lower income, as well as Black and Hispanic racial/ethnic groups.

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