“Virtual work-after-work”: the impact of telemedicine on physicians’ after-hours EHR work during the COVID-19 pandemic (Preprint)

BACKGROUND Telemedicine as a mode of healthcare work has grown dramatically during the COVID-19 pandemic; the impact of this transition on clinicians’ after-hours EHR-based clinical and administrative work is unclear. OBJECTIVE This study assesses the impact of the transition to telemedicine work during the COVID-19 pandemic on physicians’ EHR-based after-hours workload (“work-after-work”) at a large academic medical center in New York City. METHODS We conducted an EHR-based retrospective cohort study of ambulatory care physicians providing telemedicine services during the pre-pandemic, acute pandemic, and post-acute pandemic periods, relating EHR-based work after work to telemedicine intensity (percentage of care provided via telemedicine), and clinical load (patient load per provider). RESULTS 2,129 physicians were included in this study. During the acute pandemic, the volume of care provided via telemedicine significantly increased across all physicians, while patient volume decreased. When normalizing for clinical load (average appointments per day by average clinical days per week), telemedicine intensity was positively associated with work-after-work across time periods. This association was strongest in the post-acute period. CONCLUSIONS Taking physicians’ clinical load into account, physicians who devoted a higher proportion of their clinical time to telemedicine throughout the various stages of the pandemic engaged in higher levels of EHR-based after-hours than those who used telemedicine less intensively. This suggests that telemedicine may not be inherently more efficient than in-person-based care, and may not reduce the after-hours work burden of physicians. CLINICALTRIAL N/a

Tuberculosis bacillary load, an early marker of disease severity: the utility of tuberculosis Molecular Bacterial Load Assay

In this comparative biomarker study, we analysed 1768 serial sputum samples from 178 patients at 4 sites in Southeast Africa. We show that tuberculosis Molecular Bacterial Load Assay (TB-MBLA) reduces time-to-TB-bacillary-load-result from days/weeks by culture to hours and detects early patient treatment response. By day 14 of treatment, 5% of patients had cleared bacillary load to zero, rising to 58% by 12th week of treatment. Fall in bacillary load correlated with mycobacterial growth indicator tube culture time-to-positivity (Spearmans r=−0.51, 95% CI (−0.56 to −0.46), p<0.0001). Patients with high pretreatment bacillary burdens (above the cohort bacillary load average of 5.5log10eCFU/ml) were less likely to convert-to-negative by 8th week of treatment than those with a low burden (below cohort bacillary load average), p=0.0005, HR 3.1, 95% CI (1.6 to 5.6) irrespective of treatment regimen. TB-MBLA distinguished the bactericidal effect of regimens revealing the moxifloxacin—20 mg rifampicin regimen produced a shorter time to bacillary clearance compared with standard-of-care regimen, p=0.008, HR 2.9, 95% CI (1.3 to 6.7). Our data show that the TB-MBLA could inform clinical decision making in real-time and expedite drug TB clinical trials.

Influence of single physical loads of different intensity on the secretory activity of athletes blood neutrophils and monocytes

The article studies the impact of one-time physical activity of varying intensity on the secretory activity of neutrophils and monocytes in the blood of athletes of different sports specialization. Found that a single physical load average and peak levels experienced by athletes involved in aerobics, football and ran middle distance, cause a similar decrease in the expression of the secretory activity of neutrophils and monocytes in the blood, which is a decrease in the secretion of IL-1β, IL-6, IL-8, TNF-α and αIFN. Single physical loads threshold adverse effect on the functional activity of neutrophils and monocytes in athletes of different specialization do not have.

Integrated Control Strategy for Inductive Power Transfer Systems with Primary-Side LCC Network for Load-Average Efficiency Improvement

An inductive power transfer (IPT) system has lower peak efficiency and significantly lower load-average efficiency over the entire range of output power than typical power conversion systems because it transmits power wirelessly through magnetically coupled coils. In order to improve the load-average efficiency of the IPT system, this paper proposes an integrated control strategy consisting of full-bridge, phase-shift, and half-bridge control modes. The coupling coefficient and output power conditions for each control mode are theoretically analyzed, and the proposed control algorithm is established. In order to verify the analysis results, a 3.3 kW IPT system prototype is constructed, and it is experimentally verified that the load-average efficiency is improved by up to 3.75% with respect to the output power when using the proposed control scheme. In addition, the proposed control has the additional advantage that it can be directly applied to the existing IPT system without changing or adding hardware.

Assessing the Green Plantings’ Condition of Coastal and Island Territories of the Left Bank Area of Volga River (In the Context of the City of Engels)

At present, in many regions of the Russian Federation, in particular in the Saratov Region, coastal and insular recreation areas are in poor condition, both in the populated locality and in the suburban area. Today, they are inexpressive, compact, dispersed, or monotonous long-linear spaces with damaged green plantings and vegetation cover. The present study analyzes the coastal and insular recreation areas located in the city of Engels and its suburbs. The article identifies the main types of coastal and insular recreation areas, their compositional systems, areas (in ha), recreational load, average distances from the city districts to the analyzed recreation zones. The authors carried out monitoring of recreation coasts in order to determine the predominant types of green plantings. In the end of the article, the major conclusions are formulated.

Optimasi Kinerja Web Menggunakan Application-Level Cache di Sisi Server dan Browser

INTISARIPenelitian ini bertujuan untuk melakukan optimasi kinerja web menggunakan application-level cache di sisi server dan browser. Penelitian ini disusun menggunakan 2 buah VPS 1 core, memori RAM 512MB, harddisk 40GB masing-masing untuk server web dan basis data, web server Apache 2.4 dengan PHP 7.1, basis data MariaDB v.10 dengan rekayasa 20 tabel dan 10 juta tupel. Pengambilan sampel menggunakan perulangan 5x dengan kombinasi tingkat kueri dan tingkat konkurensi yang berbeda. Data dikumpulkan menggunakan aplikasi Apica Zebra Tester. Hasil analisis data menunjukkan kombinasi konfigurasi cache memiliki pengaruh yang berbeda terhadap kinerja web. Tanpa cache, kecepatan waktu akses web melambat drastis hingga 27.078,91 milidetik pada 50 konkurensi akses dan perulangan 100 kueri dengan hasil 100.000 data/kueri dengan jeda waktu 5 detik per konkurensi.Hasil penelitian membuktikan bahwa konfigurasi cache di sisi browser memiliki pengaruh peningkatan kecepatan waktu akses rata-rata 79,61% dan penurunan beban CPU 80,83% tidak stabil ketika konkurensi akses dilakukan dengan profil browser berbeda. Konfigurasi cache di sisi server memiliki pengaruh peningkatan kecepatan waktu akses rata-rata 79,83% dan penurunan beban CPU 79,88%, stabil ketika konkurensi akses dilakukan dengan profil browser berbeda. Konfigurasi cache di sisi server dan browser memiliki peningkatan pengaruh kecepatan waktu akses rata-rata tertinggi 80,07% dan penurunan beban CPU tertinggi 82,64%, sangat stabil ketika konkurensi akses dilakukan dengan profil browser berbeda. Hasil uji membuktikan, konfigurasi application-level cache paling optimal menggunakan gabungan konfigurasi cache di sisi server dan browser. Kata Kunci : optimasi kinerja web, application-level cache, web cache, cache di sisi browser, cache di sisi serverABSTRACTThis research intends to optimizing web performance using application-level cache on server-side and browser-side. This research was arranged using 2 VPS with 1 core processor, 512MB RAM, 40GB SSD, Apache 2.4 web server with PHP 7.1, MariaDB v.10 database with 20 tables and 10 million tuples. Sampling in this research using 5x loop with various query-level dan qonqurrency level.. Data were collected using Apica Zebra Tester application. Data analysis result shows the combination of cache configurations have different effects on web performance. Without cache, web access time speeds slowed dramatically to 27,078.91 milliseconds on 50 access concurrencies and 100 queries recurring with 100,000 data/query with of 5 seconds delay per concurrency. The results show the browser-side cache configuration effect has 79,61% increasing response time access average and 80,83% decrease CPU load average, unstable when the concurrency access is done with different browser profiles. The server-side cache configuration effect has 79,83% increasing response time access average and 79,88% decrease CPU load average, stable when concurrency access is made with different browser profiles. The server-side and browser-side cache configuration effect has 80,07% increasing response time access average and 82,64% decrease CPU load average, very stable when concurrency access is performed with different browser profiles. The test results prove optimal application-level cache configuration uses a combination of server-side and browser-side. Keyword : web performance optimization, application-level cache, web cache, browser-side cache, server-side cache

Twine Tension in High-Density Large Square Bales

When greater density bales are made, baler manufacturers recommend using twine with greater knot strength. When twine fails, bale integrity is lost, harvesting costs increase, and productivity suffers. Twine failure typically occurs in the knot on the top strand of the twine. A better understanding of twine tension in the top strands could help reduce failures, allow for improved knot strength recommendations, and ultimately lower baling costs. A system was developed to measure the tension of the top strands while baling a variety of crops with a high-density large square baler. Depending on the bale chute design, twine tension was greatest as the bale cantilevered from the chamber but had not yet touched the chute or just as the bale fully exited the bale chamber. In either case, the absolute maximum recorded tensions were typically less than 60% of the twine specified knot strength. Pulses in synchronization with the plunger frequency were superimposed on the nominal twine tension. Tension was usually greatest in the outer left twine and the other right twine because for each, there was only one neighboring twine to share the load. Average twine tension over the first 60 s after the bale rested on the ground was linearly related to bale density. Crop stress relaxation reduced tension up to 20% within 20 min after the bale was placed on the ground. Top strand tension approached 60% of knot strength for only a short duration as the bale exited the chamber and after that, the tension was much less than the specified knot strength. Therefore, design changes or strategies that reduce tension during the critical period when the bale exits the chamber could reduce maximum knot strength requirements and lead to lower baling costs. Keywords: Bales, Density, Tension, Twine.

The Effect of Soldier Marching, Rucksack Load, and Heart Rate on Marksmanship

Objective: The purpose was to determine if Soldier rucksack load, marching distance, and average heart rate (HR) during shooting affect the probability of hitting the target. Background: Infantry Soldiers routinely carry heavy rucksack loads and are expected to engage enemy targets should a threat arise. Method: Twelve male Soldiers performed two 11.8 km marches in forested terrain at 4.3 km/hour on separate days (randomized, counterbalanced design). The Rifleman load consisted of protective armor (26.1 kg); the Rucksack load included the Rifleman load plus a weighted rucksack (48.5 kg). Soldiers performed a live-fire shooting task (48 targets) prior to the march, in the middle of the march, and at the end of the march. HR was collected during the shooting task. Data were assessed with multilevel logistic regression controlling for the multiple observations on each subject and shooting target distance. Predicted probabilities for hitting the target were calculated. Results: There was a three-way interaction effect between rucksack load, average HR, and march ( p = .02). Graphical assessment of predicted probabilities indicated that regardless of load, marching increases shooting performance. Increases in shooting HR after marching result in lower probability of hitting the target, and rucksack load has inconsistent effects on marksmanship. Conclusion: Early evidence suggests that rucksack load and marching may not uniformly decrease marksmanship but that an inverted-U phenomenon may govern changes in marksmanship. Application: The effects of load and marching on marksmanship are not linear; the abilities of Soldiers should be continuously monitored to understand their capabilities in a given scenario.