scholarly journals December Is Coming: A Time Trend Analysis of Monthly Variation in Adult Elective Anesthesia Caseload across Florida and Texas Locations of a Large Multistate Practice

2021 ◽  
Author(s):  
Anastasia Pozdnyakova Piersa ◽  
Avery Tung ◽  
Richard P. Dutton ◽  
Sajid Shahul ◽  
David B. Glick
Keyword(s):  
Time Trends ◽  
Time Trend ◽  
Elective Surgery ◽  
Decomposition Analysis ◽  
Surgical Volume ◽  
Adult Case ◽  
Data Set ◽  
Surgical Scheduling ◽  
Insured Patients ◽  
Case Data

Background Anesthesia staffing models rely on predictable surgical case volumes. Previous studies have found no relationship between month of the year and surgical volume. However, seasonal events and greater use of high-deductible health insurance plans may cause U.S. patients to schedule elective surgery later in the calendar year. The hypothesis was that elective anesthesia caseloads would be higher in December than in other months. Methods This review analyzed yearly adult case data in Florida and Texas locations of a multistate anesthesia practice from 2017 to 2019. To focus on elective caseload, the study excluded obstetric, weekend, and holiday cases. Time trend decomposition analysis was used with seasonal variation to assess differences between December and other months in daily caseload and their relationship to age and insurance subgroups. Results A total of 3,504,394 adult cases were included in the analyses. Overall, daily caseloads increased by 2.5 ± 0.1 cases per day across the 3-yr data set. After adjusting for time trends, the average daily December caseload in 2017 was 5,039 cases (95% CI, 4,900 to 5,177), a 20% increase over the January-to-November baseline (4,196 cases; 95% CI, 4,158 to 4,235; P < 0.0001). This increase was replicated in 2018: 5,567 cases in December (95% CI, 5,434 to 5,700) versus 4,589 cases at baseline (95% CI, 4,538 to 4,641), a 21.3% increase; and in 2019: 6,103 cases in December (95% CI, 5,871 to 6,334) versus 5,045 cases at baseline (95% CI, 4,984 to 5,107), a 21% increase (both P < 0.001). The proportion of commercially insured patients and those aged 18 to 64 yr was also higher in December than in other months. Conclusions In this 3-yr retrospective analysis, it was observed that, after accounting for time trends, elective anesthesia caseloads were higher in December than in other months of the year. Proportions of commercially insured and younger patients were also higher in December. When compared to previous studies finding no increase, this pattern suggests a recent shift in elective surgical scheduling behavior. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Do Women Get Fewer Votes? No.

2018 ◽  
Vol 52 (1) ◽  
pp. 201-210 ◽  
Author(s):  
Semra Sevi ◽  
Vincent Arel-Bundock ◽  
André Blais
Keyword(s):  
Political Parties ◽  
Gender Gap ◽  
Time Trends ◽  
Large Data ◽  
Study Data ◽  
Data Set ◽  
Men And Women ◽  
Women Candidates ◽  
Percentage Points ◽  
The Difference

AbstractWe study data on the gender of more than 21,000 unique candidates in all Canadian federal elections since 1921, when the first women ran for seats in Parliament. This large data set allows us to compute precise estimates of the difference in the electoral fortunes of men and women candidates. When accounting for party effects and time trends, we find that the difference between the vote shares of men and women is substantively negligible (±0.5 percentage point). This gender gap was larger in the 1920s (±2.5 percentage points), but it is now statistically indistinguishable from zero. Our results have important normative implications: political parties should recruit and promote more women candidates because they remain underrepresented in Canadian politics and because they do not suffer from a substantial electoral penalty.

scholarly journals Time trends of vitamin D concentrations in northern Sweden between 1986 and 2014: a population-based cross-sectional study

2019 ◽  
Vol 59 (7) ◽  
pp. 3037-3044
Author(s):  
Eva Summerhays ◽  
Mats Eliasson ◽  
Robert Lundqvist ◽  
Stefan Söderberg ◽  
Tanja Zeller ◽  
...  
Keyword(s):  
Vitamin D ◽  
Time Trends ◽  
Time Trend ◽  
Population Based ◽  
Cross Sectional Study ◽  
Northern Sweden ◽  
Sectional Study ◽  
Cross Sectional ◽  
Potential Health ◽  
Entire Study

Abstract Purpose Vitamin D, produced through cutaneous photosynthesis or ingested via foods or supplements, has generated considerable research interest due to its potential health effects. However, epidemiological data on the time trends of vitamin D status are sparse, especially from northern Europe. We examined the time trend of vitamin D concentrations in northern Sweden between 1986 and 2014. Methods We used data on 11,129 men and women (aged 25–74 years) from seven population-based surveys (the Northern Sweden MONICA study), recruited between 1986 and 2014. Serum vitamin D (25-hydroxyvitamin D) status was measured using a one-step immunoassay (Abbott Architect). Multivariable linear regression models, adjusted for age, sex, and a number of other variables, were used to estimate the time trend of vitamin D concentrations. Results The mean value of vitamin D in the entire study population was 19.9 ng/mL [standard deviation (SD) 7.9], with lower values in men (19.4 ng/mL; SD 7.5) than in women (20.5 ng/mL; SD 8.2). Using the survey in 1986 as reference category, the multivariable-adjusted mean difference [95% confidence interval (CI)] in ng/mL was 2.7 (2.2, 3.3) in 1990, 3.2 (2.7, 3.7) in 1994, 1.6 (1.0, 2.1) in 1999, − 2.0 (− 2.5, − 1.4) in 2004, 1.0 (0.4, 1.5) in 2009, and 3.1 (2.5, 3.6) in 2014. Conclusion In this large cross-sectional study, we observed no clear upward or downward trend of vitamin D concentrations in northern Sweden between 1986 and 2014.

scholarly journals Results of pig carcass classification according to SEUROP in the Czech Republic

2009 ◽  
Vol 54 (No. 5) ◽  
pp. 217-228 ◽  
Author(s):  
J. Kvapilík ◽  
J. Přibyl ◽  
Z. Růžička ◽  
D. Řehák
Keyword(s):  
Statistical Models ◽  
Time Trend ◽  
Correlation Coefficients ◽  
Muscle Thickness ◽  
Data Set ◽  
The Czech Republic ◽  
Large Size ◽  
Fat Thickness ◽  
Pig Carcasses ◽  
The Eu

Through data analysis of 7 571 883 pig carcasses slaughtered from 2004 to 2007 the means of quality classes (QC) 2.32, lean meat percentage (LM) 55.83%, carcass weight (CW) 87.21 kg, muscle thickness (MT) 61.95 mm and fat thickness (FT) 15.95 mm were determined. The highest correlation coefficients are between QC and LM (<i>r</i> = –0.920), LM and FT (–0.900) as well as QC and FT (0.828), the lowest between FT and MT (<i>r</i> = –0.084). Quality class as the dominant indicator is influenced mainly by LM, which explains from 77% to 89% of variability in the case of linear regression. Among the eight methods of pig carcass classification the FOM apparatus was used the most frequently (46.5% carcasses) followed by the ULTRA-FOM 300 apparatus (15.6%), another apparatus (13.2%) and by the IS-D-05 unit (9.8%). In the statistical models used all effects (differences) are statistically significant because of the large size of the data set. The results from the separate evaluation of each cross-classified effect are that EV has the largest influence and year-season and methods have a smaller influence. The time trend (42 months) documents stable CW and MT, a slight increase in LM and improvement of QC. The estimated results indicate the successful introduction of pig carcass classification in the CR after accession to the EU.

scholarly journals Analysis of Stable Targets in High-Resolution Polarimetric SAR Data Stacks

2016 ◽  
Vol 7 (1) ◽  
pp. 10-19 ◽  
Author(s):  
B. Scheuchl
Keyword(s):  
Decomposition Analysis ◽  
Polarimetric Sar ◽  
Data Set ◽  
Full Resolution ◽  
Novel Approach ◽  
Complexity Result ◽  
Degree Of Confidence ◽  
Distributed Target ◽  
Sar Data ◽  
High Degree

Polarimetric SAR data provide information about the scattering of the area observed. The availability of data stacks allows the identification of stable targets and subsequent scattering analysis with a high degree of confidence at full resolution. A novel approach to find and evaluate polarimetric persistent target is presented, that is an extension of well-established analysis methods for single scenes. The use of the Cloude-Pottier distributed target decomposition analysis applied on the temporal averages (as opposed to spatial averaging), combined with a Cameron point target analysis applied on each layer separately to select pixels only, provides an efficient scattering classification of polarimetric persistent point targets in the stack. This method can also be used to analyze targets identified through other means, albeit at a lower degree of confidence. The approach retains the full resolution of the data set, though temporal changes between acquisitions add additional complexity. Result interpretation is therefore performed under consideration of a set of boundary conditions. Results from the analysis of two polarimetric data stacks acquired by RADARSAT-2 are shown.

scholarly journals Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach

2021 ◽  
Vol 18 (22) ◽  
pp. 11946
Author(s):  
Ailish Daly ◽  
Nicola Wolfe ◽  
Seán Paul Teeling ◽  
Marie Ward ◽  
Martin McNamara
Keyword(s):  
Six Sigma ◽  
Stakeholder Engagement ◽  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Surgical Care ◽  
Lean Six Sigma ◽  
Hospital System ◽  
Administrative Team ◽  
Surgical Scheduling ◽  
Six Sigma Methodology

The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team. Prior to commencing this project, the average time from patient consultation to being scheduled for surgery on the hospital system was 62 h/2.58 days. A pre- and post-team-based intervention design employing Lean Six Sigma methodology was applied to redesign the process for scheduling elective orthopaedic surgery. The project was informed by collaborative, inclusive, and participatory stakeholder engagement. The goal was to streamline the scheduling process for elective orthopaedic surgery, with a target that 90% of surgeries are scheduled “right first time” within 48 h/two working days of the outpatient consultant appointment. The main outcome measures showed that 100% of orthopaedic surgeries were scheduled successfully within 2 days of outpatient appointment. Duplication in work between patient services and scheduling teams was eliminated and facilitated a reduction in unnecessary staff workload. This project highlights the importance of collaborative interdisciplinary stakeholder engagement in the redesigning of processes to achieve sustainable outcomes, and the findings have informed further improvements across the hospital’s surgical scheduling system.

scholarly journals The Importance of Clinical Data for the Diagnosis of Breast Tumours in North Afghanistan

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Gerhard Stauch ◽  
Peter Fritz ◽  
Rauofi Rokai ◽  
Atiq Sediqi ◽  
Haroon Firooz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Preliminary Data ◽  
Elective Surgery ◽  
Cost Effective ◽  
Final Diagnosis ◽  
Breast Disease ◽  
Developed Countries ◽  
Needle Aspiration ◽  
Breast Diseases ◽  
Data Set

Background. This study was performed in knowledge of the increasing gap between breast disease treatment in countries with restricted resources and developed countries with increasingly sophisticated examination methods. Methods. The authors present the analysis of a breast disease register consisting of diagnostic cases from Mazar e Sharif and Herat in 2018 and 2019. The study comprises a total of 567 cases, which were presented to experts via telemedicine for final diagnosis. 62 cases (10.9%) were excluded due to inacceptable data or insufficient image quality. These data provided by daily diagnostic classification were used for the built-up of a profile for each frequent breast disease and a breast cancer register. All images and cases were seen by at least 3 independent experts. The diagnoses were made in 60% of cases by cytology of fine needle aspiration and in 40% by histological images. Results. For each entity of breast diseases (e.g., fibroadenoma), a profile of context variables was constructed allowing to assist medical decisions, as “wait and see,” elective surgery or immediate surgical intervention with R0 (complete) resection. These “profiles” could be described for fibroadenoma, mastitis, galactocele, fibrous-cystic disease, and invasive breast cancer. Conclusions. The presented preliminary data set could serve as a cost-effective basis for a North Afghan breast cancer registry, with option to extent to a national model. These preliminary data are transformed in profiles of breast diseases, which are used by the local physicians in charge of breast disease patients. Each new case can be compared by the local treating physician with the profile of all preceded cases with the same diagnosis.

2019 Chitranjan S. Ranawat Award: Elective joint arthroplasty outcomes improve in malnourished patients with nutritional intervention

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 17-21 ◽  
Author(s):  
W. C. Schroer ◽  
A. R. LeMarr ◽  
K. Mills ◽  
A. L. Childress ◽  
D. J. Morton ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Admission Rate ◽  
Nutritional Intervention ◽  
Joint Arthroplasty ◽  
High Protein ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Data Set ◽  
Anti Inflammatory ◽  
Study Hospital

Aims To date, no study has demonstrated an improvement in postoperative outcomes following elective joint arthroplasty with a focus on nutritional intervention for patients with preoperative hypoalbuminaemia. In this prospective study, we evaluated differences in the hospital length of stay (LOS), rate of re-admission, and total patient charges for a malnourished patient study population who received a specific nutrition protocol before surgery. Patients and Methods An analytical report was extracted from the electronic medical record (EMR; Epic, Verona, Wisconsin) of a five-hospital network joint arthroplasty patient data set between 2014 and 2017. A total of 4733 patients underwent joint arthroplasty and had preoperative measurement of albumin levels: 2220 at four hospitals and 2513 at the study hospital. Albumin ≤ 3.4 g/l, designated as malnutrition, was found in 543 patients (11.5%). A nutritional intervention programme focusing on a high-protein, anti-inflammatory diet was initiated in January 2017 at one study hospital. Hospital LOS, re-admission rate, and 90-day charges were compared for differential change between patients in study and control hospitals for all elective hip and knee arthroplasty patients, and for malnourished patients over time as the nutrition intervention was implemented. Results Malnourished patients with nutritional intervention at the study hospital had shorter hospital LOS beginning in 2017 than malnourished patients at control hospitals during the same period (p = 0.04). Similarly, this cohort had significantly lower primary hospitalization charges, charges associated with hospital re-admissions, and 90-day total charges (p < 0.001). Inclusion of covariant potential confounders (age, anaemia, diabetes, and obesity) did not alter the conclusions of the primary statistical analysis. Conclusion Joint arthroplasty outcomes were positively affected in study patients with low albumin when a high-protein, anti-inflammatory diet was encouraged. Elective surgery was neither cancelled nor delayed with a malnutrition designation. While the entire network population experienced improved postoperative outcomes, malnourished control patients did not experience this improvement. This study demonstrated that education on malnutrition can benefit patients. Cite this article: Bone Joint J 2019;101-B(7 Supple C):17–21

Surgical Scheduling Based on Hybrid Flow-Shop Scheduling

2012 ◽  
Vol 201-202 ◽  
pp. 1004-1007 ◽  
Author(s):  
Guo Xun Huang ◽  
Wei Xiang ◽  
Chong Li ◽  
Qian Zheng ◽  
Shan Zhou ◽  
...  
Keyword(s):  
Parallel Machines ◽  
Flow Shop ◽  
Elective Surgery ◽  
Optimal Solution ◽  
Flow Shop Scheduling ◽  
Hybrid Flow Shop ◽  
Scheduling Problem ◽  
Shop Scheduling ◽  
Surgical Scheduling ◽  
Hybrid Flow Shop Scheduling

The efficient surgical scheduling of the operating theatre plays a significant role in hospital’s income and cost. Currently surgical scheduling only considered the surgery process in operating room and ignored other stages which should not be left out in real situations. The surgical scheduling problem is regarded as the hybrid flow-shop scheduling problem in this study. Each elective surgery which need local anesthesia has to go through a two-stage surgery procedure. Beds and operating rooms are represented as parallel machines. A mathematical model for such surgical scheduling problem is proposed and solved by LINGO. A case study with its optimal solution is also presented to verify the model.

Morbidity compression, morbidity expansion, or dynamic equilibrium? The time trend of AOK-insured patients with type 2 diabetes in Lower Saxony, Germany

2016 ◽  
Vol 25 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Denise Muschik ◽  
Andrea Icks ◽  
Juliane Tetzlaff ◽  
Jelena Epping ◽  
Sveja Eberhard ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Time Trend ◽  
Dynamic Equilibrium ◽  
Lower Saxony ◽  
Insured Patients

TIME TRENDS AND DETERMINANTS OF COMPLETED FAMILY SIZE IN A RURAL COMMUNITY FROM THE BASQUE AREA OF SPAIN (1800–1969)

2003 ◽  
Vol 35 (4) ◽  
pp. 481-497 ◽  
Author(s):  
MIGUEL A. ALFONSO-SÁNCHEZ ◽  
JOSÉ A. PEÑA ◽  
ROSARIO CALDERÓN
Keyword(s):  
Family Size ◽  
Rural Community ◽  
Demographic Transition ◽  
Time Trends ◽  
Demographic Data ◽  
Principal Component ◽  
Data Set ◽  
Indirect Measure ◽  
Live Births ◽  
Completed Family Size

The focus of this work is the analysis of changes in completed family size and possible determinants of that size over time, in an attempt to characterize the evolution of reproductive patterns during the demographic transition. With this purpose in mind, time trends are studied in relation to the mean number of live births per family (as an indirect measure of fertility), using family reconstitution techniques to trace the reproductive history of each married woman. The population surveyed is a Spanish rural community called Lanciego, located at the southern end of the province of Alava (Basque Country). A total of 24,510 parish records of baptisms, marriages and burials made between 1800 and 1969 were examined to obtain the demographic data set. For each reconstituted family, the variables included in the study were the number of live births per family or family size (FAMS), year of marriage (YEAR), age at marriage of both partners (AMAN, AWOM), wife’s age at the end of marriage (WEND), duration of marriage (MARD), age at first maternity (A1CH), length of reproductive span (REPS) and number of children dying before their first anniversary (MINF). Through a principal component analysis, three factors were found that explained more than 75% of the total variance. Association of variables in factors I and III was particularly useful in characterizing the variability of mean family size in pre-transitional, transitional and post-transitional cohorts. During demographic transition, a decreasing trend is observed in the variables FAMS, REPS and MINF, while variables AWOM, AMAN, WEND and A1CH show a tendency to increase over the 20th century. Results obtained by multiple regression analysis confirm that the best predictors of family size (dependent variable) were REPS and MINF, which between them explained over 85% of the total variation in FAMS (R2=0·853). In Lanciego, birth control seems to be present on the evidence of an increase in age at first maternity and a decrease in age at last parturition, indicating that the beginning of the reproductive span is delayed and its end is brought forward. Interaction between family size and infant mortality is discussed in the light of various hypotheses, including replacement of descendants, the so-called biological effect and the theory of r and k selection.

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