scholarly journals P-O15 “Knife to Skin” time: The invariable variable

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Martin Michel ◽  
Helen Fifer ◽  
Emily Moran ◽  
Clare Bonner ◽  
Felix Hammett ◽  
...  
Keyword(s):  
Statistical Difference ◽  
Historical Data ◽  
Time Frame ◽  
Detectable Effect ◽  
Start Time ◽  
Emergency Procedures ◽  
Patient Pathways ◽  
Student’S T ◽  
The Impact ◽  
Anaesthetic Time

Abstract Background The Covid-19 pandemic has affected all aspects of healthcare globally. Theatre utilisation assumes a substantial proportion of hospital resources, creating a streamlined pathway increases efficiency and productivity. With concerns regarding aerosol generating procedures, viral transmission to health care workers in theatre and patient pathways through the hospitals the covid-19 pandemic has added another dimension to the theatre pathway. The aim of this study was to quantify the impact of Covid-19 on the “knife to skin” (KTS) time and compare it to previous historical data (HD).   Methods Retrospective analysis of real time theatre data was analysed for the first 12 months of the pandemic from 11th March 2020 to 11th March 2021. To try and minimise variability between different specialities and operations we picked one operation to study: Laparoscopic cholecystectomy (LC). Historical data was also gathered from the same time frame over the last 5 years (2015-2020) for comparison. Data collected included emergency or elective, time sent for patient, anaesthetic start time, knife to skin time and duration of operation. Comparison of means were analysed by One-way ANOVA tests and Student’s T-Test. Results 399 laparoscopic cholecystectomies were performed during the first year of the pandemic. KTS time was calculated as operation start time minus time sent for patient.  Average time during the pandemic for emergency LC KTS was 56 minutes and 35 minutes for elective LC. Comparison of these times to HD revealed no statistical difference (Emergency LC 56 mins vs 58 mins p > 0.05, Elective LC 35 mins vs 35 mins p > 0.05). The anaesthetic time for emergency LC during the pandemic vs HD was 10 mins vs 14 mins (p < 0.05), no statistical difference was found in the elective group, 16mins vs 14mins (p > 0.05) Conclusions The Covid-19 pandemic has had no detectable effect on Knife to skin time as compared to our previous historical data. It seems the extra Covid 19 precautions involving PPE, pathways etc. have not affected theatre efficiency or utilisation. In fact, there was very little variance in KTS time over the six years studied (2015-2021) with very consistent levels for both elective and emergency procedures. The shorter anaesthetic time for emergency LC during the pandemic needs to be further investigated but one hypothesis is the unconscious or conscious decision to decrease the amount of preoxygenation to minimise aerosolisation.  

scholarly journals To explore the impact of following the pre-operative fasting guidelines by ASA (American society of anesthesiologists), in improving patient outcome.

2021 ◽  
Vol 28 (7) ◽  
pp. 1018-1021
Author(s):  
Maqsood Ahmed Siddiqui ◽  
◽  
Ashok Perchani ◽  
Hamid Raza ◽  
Ahmeduddin Soomro ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Start Time ◽  
Time Duration ◽  
Cross Sectional ◽  
Emergency Procedures ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Objective: To analyze the occurrence and consequences of a prolonged preoperative-fasting. Study Design: Cross-sectional study. Setting: Large tertiary care hospital in Pakistan. Period: October 2018 to October 2019. Material & Methods: We collected data for all the procedures that occurred during the study period and divided the cases into emergency procedures, add-on procedures and elective cases. We excluded the first cases of the day and excluded the emergency and add-on cases. We studied the patients NPO duration and their scheduled start time of the procedure and compared with their actual start time of the procedure. Results: The study population was n= 434 cases. Of these 434 cases n= 164 cases were performed on time and n= 270 cases were delayed by 60 minutes or more from their scheduled time. The most frequent reason was a previous cases running longer than expected in 59.25% of the cases, the second most common reason was a change in sequence and order of the procedures which was the case for delay in 14.44% of the cases. The overall mean time of NPO for the patients was found to be 770.1 +/- 130.6 minutes, for the delayed cases the mean time duration of NPO was 812.3 +/- 105.3 minutes. The mean time of case delay was 155.2 +/- 102.7 minutes for overall cases and for the significantly delayed case the mean time period of delay was 190.2 +/- 92.1 cases. Conclusion: Our results showed that 60% of the cases have a prolonged NPO status due to delays in start of their surgical procedure as compared to the scheduled times.

Coming-of-Age Cinema in New Zealand

2017 ◽  
Author(s):  
Alistair Fox
Keyword(s):  
Coming Of Age ◽  
Belief Systems ◽  
Time Frame ◽  
New Wave ◽  
Art Cinema ◽  
Literary Sources ◽  
French New Wave ◽  
Significant Phenomenon ◽  
The Impact ◽  
New Zealanders

This book investigates the coming-of-age genre as a significant phenomenon in New Zealand’s national cinema, tracing its development from the 1970s to the present day. A preliminary chapter identifies the characteristics of the coming-of-age film as a genre, tracing its evolution and the influence of the French New Wave and European Art Cinema, and speculating on the role of the genre in the output of national cinemas. Through case studies of fifteen significant films, including The God Boy, Sleeping Dogs, The Scarecrow, Vigil, Mauri, An Angel at My Table, Heavenly Creatures, Once Were Warriors, Rain, Whale Rider, In My Father’s Den, 50 Ways of Saying Fabulous, Boy, Mahana, and Hunt for the Wilderpeople, subsequent chapters examine thematic preoccupations of filmmakers such as the impact of repressive belief systems and social codes, the experience of cultural dislocation, the expression of a Māori perspective through an indigenous “Fourth Cinema,” bicultural relationships, and issues of sexual identity, arguing that these films provide a unique insight into the cultural formation of New Zealanders. Given that the majority of films are adaptations of literary sources, the book also explores the dialogue each film conducts with the nation’s literature, showing how the time frame of each film is updated in a way that allows these films to be considered as a register of important cultural shifts that have occurred as New Zealanders have sought to discover their emerging national identity.

The Impact of Terrorism on Construction Industry in Iraq

2015 ◽  
Vol 3 (2) ◽  
pp. 69-84
Author(s):  
Wadhah Amer Hatem ◽  
Samiaah M. Hassen Al-Tmeemy
Keyword(s):  
Construction Industry ◽  
Construction Projects ◽  
Historical Data ◽  
Terrorist Attacks ◽  
Construction Sector ◽  
Statistical Procedures ◽  
Qualitative Approaches ◽  
Suicide Attacks ◽  
The Face ◽  
The Impact

     Suicide attacks, bombings, explosions became the part of daily life in Iraq. Consequently, the threat of terrorism put the Iraqi construction sector in the face of unique and unusual challenges that not seen on other countries. These challenges can have extensive impact on construction projects. This paper seeks to examine the impact of the terrorist attacks on construction industry and determine the extent to which the impact of terrorism on construction projects in terms of cost, schedule, and quality. This study adapted quantitative and qualitative approaches to collect data using questionnaire survey and interviews, as well as historical data. The study focused on projects that have been the target of terrorist strikes in Diyala governorate. A variety of statistical procedures were employed in data analysis. The results revealed the extent to which terrorist attacks impact construction projects in terms of cost, time, and quality. The results of this study will enhance the awareness of all construction parties to the impact of the terrorist attacks against construction projects. Eventually, this can develop a risk management assessment and assist contractors to properly protect projects and buildings to minimize injuries and fatalities in the event of terrorism.

scholarly journals Modeling and Estimating Volatility of Day-Ahead Electricity Prices

Mathematics ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 750
Author(s):  
Sherzod N. Tashpulatov
Keyword(s):  
Heavy Tails ◽  
Price Level ◽  
Power Market ◽  
Error Distribution ◽  
Electricity Prices ◽  
Volatility Model ◽  
Generalized Error Distribution ◽  
Student’S T ◽  
The Uk ◽  
The Impact

We model day-ahead electricity prices of the UK power market using skew generalized error distribution. This distribution allows us to take into account the features of asymmetry, heavy tails, and a peak higher than in normal or Student’s t distributions. The adequacy of the estimated volatility model is verified using various tests and criteria. A correctly specified volatility model can be used for analyzing the impact of reforms or other events. We find that, after the start of the COVID-19 pandemic, price level and volatility increased.

scholarly journals Qualitative and quantitative assessment of magnetic vestibular stimulation in humans

2020 ◽  
Vol 30 (6) ◽  
pp. 353-361
Author(s):  
Rebecca S. Dewey ◽  
Rachel Gomez ◽  
Chris Degg ◽  
David M. Baguley ◽  
Paul M. Glover
Keyword(s):  
Magnetic Field ◽  
Objective Measure ◽  
Quantitative Measure ◽  
Vestibular Stimulation ◽  
Initial Study ◽  
Clinical Test ◽  
Healthy Control ◽  
Student’S T ◽  
The Impact ◽  
The Magnetic Field

The sensation of phantom motion or exhibition of bodily sway is often reported in the proximity of an MR scanner. It is proposed that the magnetic field stimulates the vestibular system. There are a number of possible mechanisms responsible, and the relative contributions of susceptibility on the otolithic receptors and the Lorentz force on the cupulae have not yet been explored. This exploratory study aims to investigate the impact of being in the proximity of a 7.0 T MR scanner. The modified clinical test of sensory interaction on balance (mCTSIB) was used to qualitatively ascertain whether or not healthy control subjects who passed the mCTSIB in normal conditions 1) experienced subjective sensations of dizziness, vertigo or of leaning or shifting in gravity when in the magnetic field and 2) exhibited visibly increased bodily sway whilst in the magnetic field compared to outside the magnetic field. Condition IV of the mCTSIB was video recorded outside and inside the magnetic field, providing a semi-quantitative measure of sway. For condition IV of the mCTSIB (visual and proprioceptive cues compromised), all seven locations/orientations around the scanner yielded significantly more sway than at baseline (p < 0.01 FDR). A Student’s t-test comparing the RMS velocity of a motion marker on the upper arm during mCTSIB condition IV showed a significant increase in the amount of motion exhibited in the field (T = 2.59; d.f. = 9; p = 0.029) compared to outside the field. This initial study using qualitative measures of sway demonstrates that there is evidence for MR-naïve individuals exhibiting greater sway while performing the mCTSIB in the magnetic field compared to outside the field. Directional polarity of sway was not significant. Future studies of vestibular stimulation by magnetic fields would benefit from the development of a sensitive, objective measure of balance function, which can be performed inside a magnetic field.

Has tourism driven house prices in Germany? Time-varying evidence since 1870

2021 ◽  
pp. 135481662110088
Author(s):  
Sefa Awaworyi Churchill ◽  
John Inekwe ◽  
Kris Ivanovski
Keyword(s):  
World War Ii ◽  
Historical Data ◽  
House Prices ◽  
Housing Prices ◽  
Time Varying ◽  
Data Set ◽  
Time Series Modelling ◽  
The Impact ◽  
Tourism Flows ◽  
Non Parametric

Using a historical data set and recent advances in non-parametric time series modelling, we investigate the nexus between tourism flows and house prices in Germany over nearly 150 years. We use time-varying non-parametric techniques given that historical data tend to exhibit abrupt changes and other forms of non-linearities. Our findings show evidence of a time-varying effect of tourism flows on house prices, although with mixed effects. The pre-World War II time-varying estimates of tourism show both positive and negative effects on house prices. While changes in tourism flows contribute to increasing housing prices over the post-1950 period, this is short-lived, and the effect declines until the mid-1990s. However, we find a positive and significant relationship after 2000, where the impact of tourism on house prices becomes more pronounced in recent years.

scholarly journals Allograft Subsidence Decreases Postoperative Segmental Lordosis With Minimal Effect on Global Alignment Following ACDF

2021 ◽  
pp. 219256822098827
Author(s):  
Zachariah W. Pinter ◽  
Anthony Mikula ◽  
Matthew Shirley ◽  
Ashley Xiong ◽  
Scott Wagner ◽  
...  
Keyword(s):  
Global Alignment ◽  
Minimal Effect ◽  
Cervical Alignment ◽  
Entire Cohort ◽  
Patient Reported ◽  
Cage Subsidence ◽  
Student’S T ◽  
Segmental Lordosis ◽  
The Impact

Study Design: Retrospective cohort study. Objective: Studies investigating the impact of interbody subsidence in ACDF suggest a correlation between subsidence and worse radiographic and patient-reported outcomes. The purpose of this study was to assess whether allograft subsidence assessed on CT is associated with worse cervical alignment. Methods: We performed a retrospective review of a prospective cohort of patients undergoing 1 to 3 level ACDF. Cervical alignment was assessed on standing radiographs performed preoperatively, less than 2 months postoperatively, and greater than 6 months postoperatively. Allograft subsidence was assessed on CT scan performed at least 6 months postoperatively. Patients with at least 1 level demonstrating greater than 4mm of cage subsidence were classified as severe subsidence. Student’s t-test was used to compare all means between groups. Results: We identified 66 patients for inclusion, including 56 patients with non-severe subsidence and 10 patients with severe subsidence. For the entire cohort, there was a significant increase in C2-7 Lordosis (p = 0.005) and Segmental Lordosis (p < 0.00 001) from preoperative to early postoperative. On comparison of severely and non-severely subsided levels, severely subsided levels demonstrated a significantly greater loss of segmental lordosis from early to mid-term follow-up than non-severely subsided levels (-4.89 versus -2.59 degrees, p < 0.0001), manifesting as a significantly lower segmental lordosis at >6 months postoperative (0.54 versus 3.82 degrees, p < 0.00 001). There were no significant differences in global cervical alignment parameters between patients with severe and non-severe subsidence. Conclusions: Severe subsidence is associated with a significant increase in loss of segmental lordosis, but has minimal effect on global cervical alignment parameters.

scholarly journals A Hybrid Energy System Workflow for Energy Portfolio Optimization

Energies ◽  
2021 ◽  
Vol 14 (15) ◽  
pp. 4392
Author(s):  
Jia Zhou ◽  
Hany Abdel-Khalik ◽  
Paul Talbot ◽  
Cristian Rabiti
Keyword(s):  
Time Series ◽  
Gaussian Process ◽  
Electricity Market ◽  
Process Model ◽  
Net Present Value ◽  
Historical Data ◽  
Energy System ◽  
Initial Guess ◽  
Reduced Order ◽  
The Impact

This manuscript develops a workflow, driven by data analytics algorithms, to support the optimization of the economic performance of an Integrated Energy System. The goal is to determine the optimum mix of capacities from a set of different energy producers (e.g., nuclear, gas, wind and solar). A stochastic-based optimizer is employed, based on Gaussian Process Modeling, which requires numerous samples for its training. Each sample represents a time series describing the demand, load, or other operational and economic profiles for various types of energy producers. These samples are synthetically generated using a reduced order modeling algorithm that reads a limited set of historical data, such as demand and load data from past years. Numerous data analysis methods are employed to construct the reduced order models, including, for example, the Auto Regressive Moving Average, Fourier series decomposition, and the peak detection algorithm. All these algorithms are designed to detrend the data and extract features that can be employed to generate synthetic time histories that preserve the statistical properties of the original limited historical data. The optimization cost function is based on an economic model that assesses the effective cost of energy based on two figures of merit: the specific cash flow stream for each energy producer and the total Net Present Value. An initial guess for the optimal capacities is obtained using the screening curve method. The results of the Gaussian Process model-based optimization are assessed using an exhaustive Monte Carlo search, with the results indicating reasonable optimization results. The workflow has been implemented inside the Idaho National Laboratory’s Risk Analysis and Virtual Environment (RAVEN) framework. The main contribution of this study addresses several challenges in the current optimization methods of the energy portfolios in IES: First, the feasibility of generating the synthetic time series of the periodic peak data; Second, the computational burden of the conventional stochastic optimization of the energy portfolio, associated with the need for repeated executions of system models; Third, the inadequacies of previous studies in terms of the comparisons of the impact of the economic parameters. The proposed workflow can provide a scientifically defendable strategy to support decision-making in the electricity market and to help energy distributors develop a better understanding of the performance of integrated energy systems.

scholarly journals Impact of Malnutrition Status on Muscle Parameter Changes over a 5-Year Follow-Up of Community-Dwelling Older Adults from the SarcoPhAge Cohort

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 407
Author(s):  
Laetitia Lengelé ◽  
Olivier Bruyère ◽  
Charlotte Beaudart ◽  
Jean-Yves Reginster ◽  
Médéa Locquet
Keyword(s):  
Older Adults ◽  
Muscle Strength ◽  
Physical Performance ◽  
Community Dwelling ◽  
Timed Up And Go ◽  
P Values ◽  
Student’S T ◽  
The Impact ◽  
Community Dwelling Older Adults

This study aimed to assess the impact of malnutrition on the 5-year evolution of physical performance, muscle mass and muscle strength in participants from the SarcoPhAge cohort, consisting of community-dwelling older adults. The malnutrition status was assessed at baseline (T0) according to the “Global Leadership Initiatives on Malnutrition” (GLIM) criteria, and the muscle parameters were evaluated both at T0 and after five years of follow-up (T5). Lean mass, muscle strength and physical performance were assessed using dual X-ray absorptiometry, handgrip dynamometry, the short physical performance battery test and the timed up and go test, respectively. Differences in muscle outcomes according to nutritional status were tested using Student’s t-test. The association between malnutrition and the relative 5-year change in the muscle parameters was tested using multiple linear regressions adjusted for several covariates. A total of 411 participants (mean age of 72.3 ± 6.1 years, 56% women) were included. Of them, 96 individuals (23%) were diagnosed with malnutrition at baseline. Their muscle parameters were significantly lower than those of the well-nourished patients both at baseline and after five years of follow-up (all p-values < 0.05), except for muscle strength in women at T5, which was not significantly lower in the presence of malnutrition. However, the 5-year changes in muscle parameters of malnourished individuals were not significantly different than those of well-nourished individuals (all p-values > 0.05).

scholarly journals Impact of COVID-19 pandemic on non-COVID patient’s management in urology: a public hospital experience in Mumbai

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Nikhilesh A. Jibhakate ◽  
Sujata K. Patwardhan ◽  
Ajit S. Sawant ◽  
Hemant R. Pathak ◽  
Bhushan P. Patil ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Stone Disease ◽  
Outpatient Clinics ◽  
Percentage Decrease ◽  
Emergency Procedures ◽  
Number Of Patients ◽  
Long Term Impact ◽  
Tertiary Care Hospitals ◽  
The Impact ◽  
Near Future

Abstract Background To evaluate the impact of COVID-19 lockdown on non-COVID urological patient’s management in tertiary care urology centres. Methods This is an observational study in which data of patients visiting the urology department of all the MCGM run tertiary care hospitals were recorded for the duration of 1 April 2020 to 31 July 2020 and were compared to data of pre-COVID-19 period of similar duration. Results There was a decrease of 93.86% in indoor admissions of urology patients during the COVID-19 lockdown. Indoor admissions for stone disease, haematuria, malignancy accounted for 53.65%, 15.85%, 9.75%, respectively. Elective surgeries had the highest percentage decrease followed by emergency and semi-emergency procedures. There was a reduction of more than 80% in patients attending outpatient clinics. Stone disease and its consequences were the main reasons for visiting outdoor clinics (39%). A substantial number of patients presented with flank and abdominal pain (14.8%) and benign enlargement of the prostate (10.23%). Malignancy accounted for a very small number of patients visiting outdoor clinics (1.58%). Conclusions COVID-19 pandemic has a profound impact on patient care and education in Urology. There was more than ninety percent reduction in indoor admissions, operative procedures, and outpatient clinics attendance. Once the pandemic is controlled, there will be a large number of patients seeking consultation and management for urological conditions and we should be prepared for it. Surgical training of urology residents needs to be compensated in near future. Long-term impact on urological patient outcome remains to be defined.

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