1315 Improving Efficiency of I&D of Abscesses Pathway

Background It is not always possible for patients with abscesses to undergo I&D under GA on day of attendance the majority of patients wait for a space to become available on CEPOD or asked to return the next day. In 2017 an abscess pathway was introduced in TWH to help streamline these patients. This was audited and found to improve wait times from 8hr23mins to 3hrs 59mins, with 78% of patient having their operation in < 6hrs. Method Retrospective analysis of 3 months trial of the abscess pathway. (August - October 2019). Patients were identified by searching the Theatre Man theatre database for patients with codes relating to incision and drainage of abscess under the care of the Department of General Surgery. Data was collected on time referred to surgeons, time seen by surgeons, decision to admit/or ask to return and time sent for theatres. Additional information was collected on severity of symptoms and overnight stay in hospital Results Of those managed on the abscess pathway:78% received their surgery within 6 hours of arrival (25/32) - the other 7 patients had their operations later than 6 hours due to long CEPOD lists and multiple urgent operations at the same time. Average wait time from arrival in surgical assessment unit is to theatre is 4 hours 43 minutes. 32 patients were managed on the pathway, 29 had same day discharge. Two patients stayed overnight due to late time of operation (10 pm) and 1 patient was pyrexial post op

543 Improving the Management of Acute Ureteric Colic in A Multi-Centre District General Hospital: A Closed-Loop Audit

Introduction The British Association of Urological Surgeons (BAUS) released guidance in 2018 regarding the optimum management of acute ureteric colic: a condition which can present as a surgical emergency. Our aim was to review the current practice at our hospital in diagnosing and managing acute ureteric colic and ultimately, implement sustainable change to address any areas of limitations. Method The following data was retrospectively collected for of all patients admitted with acute ureteric colic: investigations performed, medications administered, details of surgical intervention and follow-up. 1st Cycle: March 2017 to February 2018. Intervention: Teaching sessions delivered to staff (including doctors and nurses) in the A&E and urology department. 2nd Cycle: January 2019 to December 2019. Results 268 patients presented to A&E with ureteric colic – 18% increase from previous year. On admission: 60.4% of patients had serum calcium checked, 97.7% had a CT KUB performed within 24 hours and 67.2% were given NSAIDs; this is a 20.4%, 0.4% and 5.2% increase from the previous year, respectively. Only 31.3% of patients had an acute surgical intervention. The average wait time for clinic follow-up was reduced to 41 days following departmental education, but only 26.4% of patients were seen within the BAUS advised 4-week timeframe. Conclusions Re-audit showed distinct improvement in the management of acute ureteric colic. Thus, departmental education strategies have had a positive impact. It is recommended that the reservation of one daily elective theatre slot for an emergency operation and a computerised clinic booking system will further optimise our management in line with BAUS guidance.

Shared Low-Speed Autonomous Vehicle System for Suburban Residential Areas

In the context of global suburbanization and population aging, a low-speed, automated vehicle (LSAV) system provides essential mobility services in suburban residential areas. Although extensive studies on shared autonomous vehicle (SAV) services have been conducted, quantitative investigations on the operation of suburban LSAV systems are limited. Based on a demonstration pilot project of an autonomous vehicle called “Slocal Automated Driving”, we investigated the performance of an SAV system considering several scenarios in Kozoji Newtown, a suburban commuter town in Japan. The agent-based simulation results revealed that 40 LSAVs can satisfy the demands of 2263 daily trips with an average wait time of 15 min. However, in the case of a high-speed scenario, the same fleet size improved the level of service (LOS) by reducing the average wait time to two and a half minutes and halving the in-vehicle time. By contrast, the wait time in terms of the average and 95th percentile of the no-sharing ride scenario drastically deteriorated to an unacceptable level. Based on the fluctuations of hourly share rates, wait times, and the number of vacant vehicles, we determined that preparing for the potential fleet insufficiency periods from 7:00–13:00 and 15:00–18:00 can improve the LOS.

572 Utility of Split Night Polysomnograms in Children

Introduction Overnight in-lab polysomnograms (PSG) are the gold standard for diagnosis of sleep disordered breathing in children. As the wait time for adenotonsillectomy (T & A) at our institution was several months, we implemented split night PSGs with positive airway pressure (PAP) during the initial diagnostic PSG if AHI>30 (Emergency SNPSG). Planned SNPSG were performed on children who are undergoing PSG after T & A, eliminating follow-up titration PSG if the PSG is positive for OSA (residual AHI>10/hour). We present data on the outcomes of the SNPSG. Methods Retrospective chart review of consecutive SNPSGs done over last 2 years at our institution was performed. Data on SNPSGs (planned or emergency), age, sex, diagnostic study duration, diagnostic study AHI, PAP pressure and subsequent PAP adherence were collected. Data on sleep efficiency, arousal, sleep architecture, REM sleep were compared between diagnostic and titration part of the SNPSG. Study was considered successful if patient was able to tolerate PAP during titration and also if adherent to PAP at follow up. Results 48 studies met the criteria for SNPSG, with 60% of SNPSG being emergency SNPSG with AHI>30. Our cohort’s age ranged from 2–18 years (median age 8 years); 33 were males. Majority of the emergency SNPSG were in younger children (80% < 5 years), 75% of them continued to use PAP (mostly CPAP) until T & A with wait time being more than 3 months. Average wait time for T & A was 4 months. 25% of patients continued to use PAP following T & A as residual AHI was >10/hour. 98% of the patients were able to tolerate PAP during titration section with restoration of sleep architecture including REM with reduction in AHI, arousals and improved sleep efficiency. Bilevel PAP was used in 10% of patients in mostly planned SNPSG. Conclusion SNPSG can be implemented with fair degree of success during initial PSG with PAP used until T & A is performed. Planned SNPSG are also useful with residual severe OSA eliminating need for subsequent titration study. When indicated, 75% of our cohort continued to use PAP with fair adherence (>70% nightly use) following SNPSG. Support (if any):

The COVID States Project #33: Update on COVID-19 test turnaround times across the country

Rapid delivery of COVID-19 test results are essential for the nation’s pandemic response. Our 50-state survey results reveal that testing times are decreasing, albeit slowly (see Figure 1).1 For respondents whose last nasal swab COVID-19 test was in March, the average result turnaround time was 3.9 days (with a median of 3.0 days); in December, the average time was 2.2 days (median of 2.0 days).2 Unfortunately, racial disparities still exist in testing times; in December, Hispanic and Black respondents waited 0.7 and 0.4 days longer than white respondents, respectively.We also measure respondents’ access to COVID-19 testing by asking, “How many days did you have to wait between the time you decided on a test and the day you were tested?” (Figures 2 and 3). Responses indicate that difficulty in obtaining COVID-19 tests has decreased somewhat, although race and ethnicity matter again: in December, Asian, Hispanic, and Black respondents had to wait 1.5, 1.4, and 0.9 days longer than white respondents (average wait time of 2.0 days) to receive a test.Despite an overall trend of increased access and reduced result times, as of December, the average time between the decision to get tested and the actual test (2.4 days) plus the average time to receive test results after getting tested (2.2 days) remains too long to support effective contact tracing.

An evaluation of the current status of kidney transplant in terms of the type of receipt among Iranian patients

Introduction With the increasing prevalence and incidence of chronic renal failure leading to advanced kidney disease (ESRD), the use of renal transplant therapy is increasing globally. The aim of this study was to determine the status of kidney transplant in patients during a period of 4–5 years. Materials and methods In this retrospective, analytical study, patients undergoing renal transplant at one of the hospitals in northern Iran were studied. The data was collected using a checklist assessing the required information, including the age, sex, place of residence, source of the kidney for transplant (living related, living non-related, deceased), kidney receiving method (donated, purchased), and wait time for a kidney transplant. Results A total of 228 patients were included in the study, of which 73.7% were male and 26.3% were female. The average wait time for kidney transplant was 386.22 days. The mean age of patients was 32.7 ± 10.7 years. In addition, living non-related (66.2%) and deceased (14%) were the most and least frequent sources of kidney transplant, respectively. Moreover, 51.8% of all transplanted kidneys were purchased. Conclusion Over the past 5 years, there has been a decrease in wait time for kidney transplant in Rasht, Iran. Factors, such as being female, lower age, and living in urban areas, are related to a shorter wait time for kidney transplant. The most common types of kidney transplant are from non-related donors and purchased.

Using Wait-time Thresholds to Improve Mobility: The Case of UberWAV Services in Toronto

We examine the wait-time of Uber’s wheelchair accessible service (UberWAV) in Toronto, to determine whether it meets the City’s 11-minutes average wait-time requirement. Using a 12-million record dataset of every ride-hailing trip conducted in Toronto between September 2016 and March 2017, we show that wait-times for UberWAV services were, on average, longer during rush hour periods and for trips further away from downtown. Despite this, we find that UberWAV services met the average wait-time requirement imposed by the City and believe that by offering shorter wait-times than previously available, this service significantly improves the mobility of people who require accessible transport services.

Giant pulses from J1823−3021A observed with the MeerKAT telescope

ABSTRACT The millisecond pulsar J1823−3021A is a very active giant pulse emitter in the globular cluster NGC 6624. New observations with the MeerKAT radio telescope have revealed 14350 giant pulses over 5 h of integration time, with an average wait time of about 1 s between giant pulses. The giant pulses occur in phases compatible with the ordinary radio emission, follow a power-law distribution with an index of −2.63 ± 0.02, and contribute 4 per cent of the total integrated flux. The spectral index of the giant pulses follows a Gaussian distribution centred around −1.9 with a standard deviation of 0.6 and is on average flatter than the integrated emission, which has a spectral index of −2.81 ± 0.02. The waiting times between the GPs are accurately described by a Poissonian distribution, suggesting that the time of occurrence of a GP is independent from the times of occurrence of other GPs. 76 GPs show multiple peaks within the same rotation, a rate that is also compatible with the mutual independence of the GP times of occurrence. We studied the polarization properties of the giant pulses finding, on average, linear polarization only at the 1 per cent level and circular polarization at the 3 per cent level, similar to the polarization percentages of the total integrated emission. In four cases, it was possible to measure the RM of the GPs that are highly variable and, in two cases, is inconsistent with the mean RM of the total integrated pulsar signal.

THE STATE OF THE NATION: A 50-STATE COVID-19 SURVEY REPORT #8: FAILING THE TEST

Rapid turnaround of testing for COVID-19 infection is essential to containing the pandemic. Ideally, test results would be available the same day. Our findings indicate that the United States is not currently performing testing with nearly enough speed. In our large (19,058 respondents) national survey, conducted between July 10 and 26, we asked whether respondents had been tested for COVID-19 and how long they had waited to get results. Our finding: 37% of those who had been tested by nasal swab received results within 2 days, and the average wait time was 4.1 days; with 31% of tests taking more than 4 days, and 10% 10 days or more. Further, there are few signs that turnaround times are diminishing. For individuals who responded that their last test had been in April, they had waited on average 4.2 days to get results; and for individuals tested in July, 4.1 days.

Security-aware fair transmission scheme for 802.11 based cognitive IoT

Cognitive IoT is exponentially increased because of various real time and robust applications with sensor networks and big data analysis. Each IoT protocol of network layer can be RPL, COAP and so on based on IETF standards. But still collision problems and security-aware fair transmission on top of scalable IoT devices were not solved enough. In the open wireless LAN system based cognitive IoTs, IoT node that is continuously being stripped of its transmission opportunity will continue to accumulate packets to be sent in the butter and spoofing attacks will not allow the data transfer opportunities to be fair. Therefore, in this paper, we propose a method to reduce the average wait time of all packets in the system by dynamically controlling the contention window (CW) in a wireless LAN based cognitive IoT environment where there are nodes that do not have fair transmission opportunities due to spoofing attacks. Through the performance evaluation, we have proved that the proposed technique improves up to 80% in terms of various performance evaluation than the basic WLAN 802.11 based IoT.