The inequality of stroke in 2022: The impact of geography, COVID-19, and time of day, on stroke outcomes

Objective Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting. Methods Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models. Results Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation. Conclusions This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.

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82 The impact of feeding treats containing cannabidiol (CBD) on the daily activity level of dogs

Journal of Animal Science ◽

10.1093/jas/skaa278.109 ◽

2020 ◽

Vol 98 (Supplement_4) ◽

pp. 60-61

Author(s):

Elizabeth M Morris ◽

Susanna E Kitts-Morgan ◽

Dawn M Spangler ◽

Kyle R McLeod ◽

David L Harmon

Keyword(s):

Daily Activity ◽

Block Design ◽

Companion Animals ◽

Total Activity ◽

Time Of Day ◽

Activity Level ◽

Activity Levels ◽

Quiet Time ◽

Activity Duration ◽

The Impact

Abstract Growing public interest in and use of Cannabidiol (CBD) in companion animals has amplified the need to elucidate potential impacts. The purpose of this investigation was to determine the impact of CBD on daily activity of adult dogs. Twenty-four dogs (18.0 ± 3.4 kg) were utilized in a randomized complete block design with treatments consisting of control, 2 mg CBD/kg BW/d, and 4 mg CBD/kg BW/d split between two treats administered after twice-daily exercise (7:00-9:00 and 17:00-19:00). Four hours each day (10:00-12:00, AM and 13:30-15:30, PM), were designated as time when no persons entered the kennels, with 2 h designated as Quiet Time and the other 2 h as Music Time, where calming music played over speakers. Quiet and Music sessions were randomly allotted to daily AM or PM times. Activity monitors were fitted to dogs’ collars for continuous collection of activity parameters. Data were collected over a 2-wk baseline period to block dogs by activity level (high or low) before randomly assigning dogs within each block to treatments. After 1 wk of treatment adaptation, activity parameters were collected for 2 wk. Data were tested for normality using the UNIVARIATE procedure in SAS before examining differences using the MIXED procedure in SAS, including effects of treatment, day, session (Quiet or Music), time of day (AM or PM), and accompanying interactions. CBD did not alter total activity points (P = 0.9971) or activity duration (P = 0.8776). CBD tended (P = 0.0692) to reduce scratching compared to control. Irrespective of treatment, dogs were more active in PM than AM (P < 0.0001). Regardless of session, dogs receiving 4 mg/kg/d tended (P = 0.0914) to be less active in the PM than control. CBD did not affect activity duration during exercise periods (P = 0.1425), but dogs receiving CBD ran more than control (P = 0.0339). These results indicate that when supplemented up to 4 mg/kg/d, CBD does not negatively impact daily activity levels of dogs.

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Influence of Land Cover and Soil Moisture on the Horizontal Distribution of Sensible and Latent Heat Fluxes in Southeast Kansas during IHOP_2002 and CASES-97

Journal of Hydrometeorology ◽

10.1175/jhm554.1 ◽

2007 ◽

Vol 8 (1) ◽

pp. 68-87 ◽

Cited By ~ 71

Author(s):

Margaret A. LeMone ◽

Fei Chen ◽

Joseph G. Alfieri ◽

Mukul Tewari ◽

Bart Geerts ◽

...

Keyword(s):

Soil Moisture ◽

Latent Heat ◽

Land Surface ◽

Field Experiments ◽

Time Of Day ◽

Horizontal Distribution ◽

Heat Fluxes ◽

Surface Model ◽

Green Vegetation ◽

The Impact

Abstract Analyses of daytime fair-weather aircraft and surface-flux tower data from the May–June 2002 International H2O Project (IHOP_2002) and the April–May 1997 Cooperative Atmosphere Surface Exchange Study (CASES-97) are used to document the role of vegetation, soil moisture, and terrain in determining the horizontal variability of latent heat LE and sensible heat H along a 46-km flight track in southeast Kansas. Combining the two field experiments clearly reveals the strong influence of vegetation cover, with H maxima over sparse/dormant vegetation, and H minima over green vegetation; and, to a lesser extent, LE maxima over green vegetation, and LE minima over sparse/dormant vegetation. If the small number of cases is producing the correct trend, other effects of vegetation and the impact of soil moisture emerge through examining the slope ΔxyLE/ΔxyH for the best-fit straight line for plots of time-averaged LE as a function of time-averaged H over the area. Based on the surface energy balance, H + LE = Rnet − Gsfc, where Rnet is the net radiation and Gsfc is the flux into the soil; Rnet − Gsfc ∼ constant over the area implies an approximately −1 slope. Right after rainfall, H and LE vary too little horizontally to define a slope. After sufficient drying to produce enough horizontal variation to define a slope, a steep (∼−2) slope emerges. The slope becomes shallower and better defined with time as H and LE horizontal variability increases. Similarly, the slope becomes more negative with moister soils. In addition, the slope can change with time of day due to phase differences in H and LE. These trends are based on land surface model (LSM) runs and observations collected under nearly clear skies; the vegetation is unstressed for the days examined. LSM runs suggest terrain may also play a role, but observational support is weak.

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Modeling Mine Workforce Fatigue: Finding Leading Indicators of Fatigue in Operational Data Sets

Minerals ◽

10.3390/min11060621 ◽

2021 ◽

Vol 11 (6) ◽

pp. 621

Author(s):

Elaheh Talebi ◽

W. Pratt Rogers ◽

Tyler Morgan ◽

Frank A. Drews

Keyword(s):

Health And Safety ◽

Time Of Day ◽

Weather Data ◽

Data Sets ◽

Leading Indicators ◽

Safety Control ◽

Model Complex ◽

Fatigue Monitoring ◽

The Impact ◽

Operational Data

Mine workers operate heavy equipment while experiencing varying psychological and physiological impacts caused by fatigue. These impacts vary in scope and severity across operators and unique mine operations. Previous studies show the impact of fatigue on individuals, raising substantial concerns about the safety of operation. Unfortunately, while data exist to illustrate the risks, the mechanisms and complex pattern of contributors to fatigue are not understood sufficiently, illustrating the need for new methods to model and manage the severity of fatigue’s impact on performance and safety. Modern technology and computational intelligence can provide tools to improve practitioners’ understanding of workforce fatigue. Many mines have invested in fatigue monitoring technology (PERCLOS, EEG caps, etc.) as a part of their health and safety control system. Unfortunately, these systems provide “lagging indicators” of fatigue and, in many instances, only provide fatigue alerts too late in the worker fatigue cycle. Thus, the following question arises: can other operational technology systems provide leading indicators that managers and front-line supervisors can use to help their operators to cope with fatigue levels? This paper explores common data sets available at most modern mines and how these operational data sets can be used to model fatigue. The available data sets include operational, health and safety, equipment health, fatigue monitoring and weather data. A machine learning (ML) algorithm is presented as a tool to process and model complex issues such as fatigue. Thus, ML is used in this study to identify potential leading indicators that can help management to make better decisions. Initial findings confirm existing knowledge tying fatigue to time of day and hours worked. These are the first generation of models and future models will be forthcoming.

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Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽

10.1161/str.52.suppl_1.p119 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nicolle W Davis ◽

Meghan Bailey ◽

Natalie Buchwald ◽

Amreen Farooqui ◽

Anna Khanna

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Patient Outcomes ◽

Time Of Day ◽

Stroke Patients ◽

Acute Stroke Care ◽

The Impact ◽

Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

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Examining the Impact of Adverse Weather on Travel Time Reliability of Urban Corridors in Shanghai

Journal of Advanced Transportation ◽

10.1155/2020/8860277 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Yajie Zou ◽

Ting Zhu ◽

Yifan Xie ◽

Linbo Li ◽

Ying Chen

Keyword(s):

Travel Time ◽

Weather Condition ◽

Time Of Day ◽

Weather Data ◽

Time Variability ◽

Travel Time Reliability ◽

Time Data ◽

Adverse Weather Condition ◽

Adverse Weather ◽

The Impact

Travel time reliability (TTR) is widely used to evaluate transportation system performance. Adverse weather condition is an important factor for affecting TTR, which can cause traffic congestions and crashes. Considering the traffic characteristics under different traffic conditions, it is necessary to explore the impact of adverse weather on TTR under different conditions. This study conducted an empirical travel time analysis using traffic data and weather data collected on Yanan corridor in Shanghai. The travel time distributions were analysed under different roadway types, weather, and time of day. Four typical scenarios (i.e., peak hours and off-peak hours on elevated expressway, peak hours and off-peak hours on arterial road) were considered in the TTR analysis. Four measures were calculated to evaluate the impact of adverse weather on TTR. The results indicated that the lognormal distribution is preferred for describing the travel time data. Compared with off-peak hours, the impact of adverse weather is more significant for peak hours. The travel time variability, buffer time index, misery index, and frequency of congestion increased by an average of 29%, 19%, 22%, and 63%, respectively, under the adverse weather condition. The findings in this study are useful for transportation management agencies to design traffic control strategies when adverse weather occurs.

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Is Nighttime Really Not the Right Time for a Laparoscopic Cholecystectomy?

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/6076948 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Anna C. M. Geraedts ◽

Meindert N. Sosef ◽

Jan Willem M. Greve ◽

Mechteld C. de Jong

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Morbidity ◽

Time Of Day ◽

Outcome Data ◽

Emergency Procedure ◽

Out Of Hours ◽

Increased Risk ◽

The Right ◽

The Impact ◽

Univariate Analyses

Purpose. The impact of an out-of-hours laparoscopic cholecystectomy on outcome is controversial. We sought to determine the association between an out-of-hours procedure and postoperative complications within 90 days. Methods. Between 2014 and 2016, 1553 laparoscopic cholecystectomies were performed. Therapeutic, operative, and outcome data were prospectively collected and analyzed. We defined out of hours as during weekends, national holidays, and daily between 5PM and 8AM. Results. Most patients operated on were female (n=988; 63.6%) and the majority of procedures were electives (n=1341; 86.3%). Although all procedures were performed with a laparoscopic intent, 42 (2.7%) were converted to open procedure. In total, 145 (9.3%) procedures were out of hours, all nonelective, and in most cases for acute cholecystitis (n=111; 7.1%). Overall, there were 212 complications in 191 patients (12.3%), most (n=153; 9.9%) classified as minor. The conversion rate in the out-of-hours group was significantly higher (9.7% vs 2.0%; p<0.001). While univariate analyses revealed out-of-hours procedure (OR=1.83; p=0.008) to be associated with an increased risk of complications, when controlling for confounding factors by multivariate analysis, this association was not found. However, operation by surgical staff (OR=1.71) and conversion to laparotomy (OR=3.74) were found to be independently associated with an increased risk of complications (both p<0.05), while an emergency procedure tended to be associated with postoperative morbidity (OR=1.82; p=0.069). Conclusion. An out-of-hours laparoscopic cholecystectomy was not found to be an independent risk factor for developing postoperative morbidity and time of day should therefore only be a relative contraindication.

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Implications of remote monitoring Technology in Optimizing Traditional Self-Monitoring of blood glucose in adults with T2DM in primary care

BMC Endocrine Disorders ◽

10.1186/s12902-021-00884-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alex R. Montero ◽

David Toro-Tobon ◽

Kelly Gann ◽

Carine M. Nassar ◽

Gretchen A. Youssef ◽

...

Keyword(s):

Primary Care ◽

Blood Glucose ◽

Diabetes Care ◽

Remote Monitoring ◽

Secondary Analysis ◽

Time Of Day ◽

Trial Registration ◽

Blood Glucose Monitoring ◽

Self Monitoring ◽

The Impact

Abstract Background Self-monitoring of blood glucose (SMBG) has been shown to reduce hemoglobin A1C (HbA1C). Accordingly, guidelines recommend SMBG up to 4–10 times daily for adults with type 2 diabetes (T2DM) on insulin. For persons not on insulin, recommendations are equivocal. Newer technology-enabled blood glucose monitoring (BGM) devices can facilitate remote monitoring of glycemic data. New evidence generated by remote BGM may help to guide best practices for frequency and timing of finger-stick blood glucose (FSBG) monitoring in uncontrolled T2DM patients managed in primary care settings. This study aims to evaluate the impact of SMBG utility and frequency on glycemic outcomes using a novel BGM system which auto-transfers near real-time FSBG data to a cloud-based dashboard using cellular networks. Methods Secondary analysis of the intervention arm of a comparative non-randomized trial with propensity-matched chart controls. Adults with T2DM and HbA1C > 9% receiving care in five primary care practices in a healthcare system participated in a 3-month diabetes boot camp (DBC) using telemedicine and a novel BGM to support comprehensive diabetes care management. The primary independent variable was frequency of FSBG. Secondary outcomes included frequency of FSBG by insulin status, distribution of FSBG checks by time of day, and hypoglycemia rates. Results 48,111 FSBGs were transmitted by 359 DBC completers. Participants performed 1.5 FSBG checks/day; with 1.6 checks/day for those on basal/bolus insulin. Higher FSBG frequency was associated with greater improvement in HbA1C independent of insulin treatment status (p = 0.0003). FSBG frequency was higher in patients treated with insulin (p = 0.003). FSBG checks were most common pre-breakfast and post-dinner. Hypoglycemia was rare (1.2% < 70 mg/dL). Conclusions Adults with uncontrolled T2DM achieved significant HbA1C improvement performing just 1.5 FSBGs daily during a technology-enabled diabetes care intervention. Among the 40% taking insulin, this improvement was achieved with a lower FSBG frequency than guidelines recommend. For those not on insulin, despite a lower frequency of FSBG, they achieved a greater reduction in A1C compared to patients on insulin. Low frequency FSBG monitoring pre-breakfast and post-dinner can potentially support optimization of glycemic control regardless of insulin status in the primary care setting. Trial registration Trial registration number:NCT02925312 (10/19/2016).

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Characteristics of Marine Recreational Fishing in the anakkale Strait (Turkey)

Mediterranean Marine Science ◽

10.12681/mms.79 ◽

2010 ◽

Vol 11 (2) ◽

pp. 315 ◽

Cited By ~ 21

Author(s):

V. UNAL ◽

D. ACARLI ◽

A. GORDOA

Keyword(s):

Time Of Day ◽

Recreational Fishing ◽

Commercial Fishing ◽

Catch Per Unit Effort ◽

Pomatomus Saltatrix ◽

Night Time ◽

Policy Information ◽

Surveillance Programs ◽

Catch Composition ◽

The Impact

The economic and harvest impacts of Marine Recreational Fishing (MRF) in Çanakkale Strait were analysed along with fishing policy, sociology and habits of fishers. Data sources included field survey data carried out along the entire length of the Çanakkale strait and policy information gathered from published sources. MRF policy is commendable, even in the fishing tourism sector, and is better developed than that in many other European countries. In Çanakkale, 9.9% of the population is recreational fishers. Recreational fishers are typically men (90%), primarily those between the ages of 25 and 49 yrs. The occupation of the recreational fishers ranged from self-employed (28%), students (28%), retired persons (22%) and public employees (15%), to currently-unemployed persons (7%). An analysis of diel behaviour showed that most recreational fishers preferred fishing during the day (56.1%), while the evening was the next most preferred time for fishing (18%), followed by the night-time (9.8%), while a substantial number of recreational fishers (16.1%) reported that they fished at any time of day. The most popular type of fishing was shore-based (68%), followed by boat-based (21%), and underwater fishing (11%). The mean daily fishing times were 6.07 h d-1, 6.18 h d-1 4.75 d-1 for boat-based, underwater and shore-based fishing, respectively. Summer and autumn were the preferred seasons for shore-based and underwater fishing, while autumn and winter were preferred for boat-based fishing. The highest Catch per Unit Effort (CPUE) was observed for boat-based fishing (2.77 kg h-1), followed by underwater (0.97 kg h-1) and shore-based fishing (0.81 kg h-1). The catch composition included 51 species, though the catch composition of each fishing type was mostly comprised of only 3 or 4 species. The impact of the MRF harvest was high (30% of commercial fishing), particularly for bluefish (Pomatomus saltatrix) and picarel (Spicara smaris) species. The economic impact of MRF was highly negative. Several indicators including the following revealed a high percentage of trading catch (47%) being conducted under the guise of a recreational label: annual fishing intensity, total costs, target species, and sales. At present, it is evident that the highly developed recreational fishing policy in Turkey is not sufficient to ensure that recreational fishing is sustainable or to prevent fishing conflicts in Turkey. This study revealed the need for establishing monitoring, control and surveillance programs to ensure the sustainability of fish resources and fisheries including MRF.

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An Examination of Circadian Impacts on Judgments

Social Psychology ◽

10.1027/1864-9335/a000420 ◽

2020 ◽

Vol 51 (5) ◽

pp. 341-353

Author(s):

David L. Dickinson ◽

Andrew R. Smith ◽

Robert McClelland

Keyword(s):

Adverse Effects ◽

Sleep Deprivation ◽

Time Of Day ◽

Optimal Time ◽

Insufficient Sleep ◽

Circadian Timing ◽

Evidence Strength ◽

The Impact

Abstract. Many people suffer from insufficient sleep and the adverse effects of sleep deprivation are well documented. Research has shown that people’s judgments can be affected by circadian timing. Across three studies, we examined the impact of time-of-day on people’s judgments about hypothetical legal scenarios, hypothesizing that participants responding at a suboptimal time of day (3–5 a.m.) would give higher guilt ratings and be less sensitive to case information (e.g., evidence strength) than participants responding at a more optimal time of day (2–4 p.m.). Although the time-of-day manipulation influenced participants’ self-reported alertness levels, time-of-day did not affect guilt judgments or sensitivity to case information. This research adds to the literature on how extraneous factors may and may not impact probability assessments.

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