Evaluation of the Time Spent by Anesthetist on Clinical Tasks in the Operating Room

BackgroundChanges in the health system in Western countries have increased the scope of the daily tasks assigned to physicians', anesthetists included. As already shown in other specialties, increased non-clinical burden reduces the clinical time spent with patients.MethodsThis was a multicenter, prospective, observational study conducted in 6 public and private hospitals in France. The primary endpoint was the evaluation by an external observer of the time spent per day (in minutes) by anesthetists on clinical tasks in the operating room. Secondary endpoints were the time spent per day (in minutes) on non-clinical organizational tasks and the number of task interruptions per hour of work.ResultsBetween October 2017 and April 2018, 54 anesthetists from six hospitals (1 public university hospital, two public general hospitals and three private hospitals) were included. They were followed for 96 days corresponding to 550 hours of work. The proportion of overall clinical time was 62% (58% 95%CI [53; 63] for direct care. The proportion of organizational time was higher in public hospitals (11% in the university hospital (p < 0.001) and 4% in general hospitals (p < 0.01)) compared to private hospitals (1%). The number of task interruptions (1.5/h ± 1.4 in all hospitals) was 4 times higher in the university hospital (2.2/h ± 1.6) compared to private hospitals (0.5/h ± 0.3) (p < 0.05).ConclusionsMost time in the operating room was spent on clinical care with a significant contrast between public and private hospitals for organizational time.

The effortful and invisible cost of repairing speech misperceptions by individuals who use cochlear implants

PurposeSpeech recognition percent-correct scores fail to capture the effort of mentally repairing the perception of speech that was initially misheard. This study includes two experiments to simulate and measure the effort of this experience of mental repair, from the perspective of both listener and talker.MethodsCochlear implant (CI) listeners heard and repeated sentences where single words were distorted or masked by noise, but recoverable based on later context – a signature of mental repair. Changes in pupil dilation were tracked as an index of effort and time-locked with specific landmarks during perception. Later, audio recordings of the participants’ responses were played for outside observers who judged whether they thought the CI user mentally repaired a word.ResultsEffort significantly increases when a listener needs to repair a misperceived word, even if the verbal response is ultimately correct. That increased effort lasts longer for CI users than for listeners with normal hearing. There was no success in detecting that effort by nearly 200 external observers including audiologists and others who profess to have experience and skill in conversing with people who have hearing loss. Mental repair of words in a sentence were accompanied by greater prevalence of errors elsewhere in the same sentence, suggesting that effort spreads to consume resources across time. ConclusionsListening effort is better explained by the mental repair and reconstruction of words rather than the appearance of correct or incorrect perception. Linguistic coherence drives effort more heavily than the mere presence of mistakes, highlighting the importance of effort that cannot be tracked with individual words or digits. However, an external observer is not able to reliably detect that extra effort in the listener’s voice.

Emotional Response to Stories in Interactive Narrative

<p>The audience enjoys stories more if they present suspense. This is true for both non-interactive and interactive narratives. However, in interactive stories, for example in the context of a video game, suspense perception can be influenced by two factors: the audience’s choice and repeated exposition to the same story episode presenting suspense. Currently, there has been little research done on the audience’s emotional response to interactive narrative and the purpose of this thesis is to contribute to this area. The dissertation addresses nine research questions: (1) “How does a level of suspense change with repeated encounters?” (2) “How do choices offered to the audience influence their suspense perception?” (3) “Is the level of suspense reported from a distant observer perspective comparable to the degree of suspense experienced by the audience member immersed in the story and considering himself as a story character?" (4) Does a degree of suspense depend on the perspective from which the story is perceived (story character or external observer)? 5) “Does more suspense necessarily lead to the greater story enjoyment in interactive narratives?” (6) “How can one keep suspense high with repeated encounters in the interactive narratives?” (7) “Does greater uncertainty about the story outcome result in the greater degree of suspense?" (8) “Do male and female members of the audience perceive suspense differently in interactive stories?” (9) “Do the age and gaming experience of audience correlate with the degree of suspense they experience in interactive narratives?” In order to answer these questions, the dissertation employed two approaches – theoretical analysis and empirical study. The theoretical part of the thesis addressed the questions of the role of suspense in interactive narrative, the process of the audience’s involvement in the interactive narrative and its possible impact on suspense perception, as well as how the degree of suspense perceived in the story can be influenced by the interactive mode of the story through manipulating the choice. For the empirical research, quantitative methodology has been employed and one hundred and forty two participants took part in three experiments where they were asked to read and re-read non-interactive and interactive versions of a story created on the base of James Bond novels. The core data was collected from self-reports and surveys that the participants were asked to complete during and after experiments. Additional data came from the participants’ comments on their experience during the experiments. This thesis makes two main contributions to the study of interactive narrative and narrative-based video games. First, it empirically proves that choice does not reduce the level of perceived suspense in the interactive story as it has been argued by some scholars (i.e. Frome & Smuts, 2004). . Second, the results of the research suggest that by manipulating the choice offered to the audience it is possible to keep the level of suspense higher with repeated encounters. In addition, some other findings obtained from the experiments present factors that may influence suspense perception in interactive narrative such as the gender of the audience members, their gaming experience, and level of immersion in the story.</p>

Emotional Response to Stories in Interactive Narrative

<p>The audience enjoys stories more if they present suspense. This is true for both non-interactive and interactive narratives. However, in interactive stories, for example in the context of a video game, suspense perception can be influenced by two factors: the audience’s choice and repeated exposition to the same story episode presenting suspense. Currently, there has been little research done on the audience’s emotional response to interactive narrative and the purpose of this thesis is to contribute to this area. The dissertation addresses nine research questions: (1) “How does a level of suspense change with repeated encounters?” (2) “How do choices offered to the audience influence their suspense perception?” (3) “Is the level of suspense reported from a distant observer perspective comparable to the degree of suspense experienced by the audience member immersed in the story and considering himself as a story character?" (4) Does a degree of suspense depend on the perspective from which the story is perceived (story character or external observer)? 5) “Does more suspense necessarily lead to the greater story enjoyment in interactive narratives?” (6) “How can one keep suspense high with repeated encounters in the interactive narratives?” (7) “Does greater uncertainty about the story outcome result in the greater degree of suspense?" (8) “Do male and female members of the audience perceive suspense differently in interactive stories?” (9) “Do the age and gaming experience of audience correlate with the degree of suspense they experience in interactive narratives?” In order to answer these questions, the dissertation employed two approaches – theoretical analysis and empirical study. The theoretical part of the thesis addressed the questions of the role of suspense in interactive narrative, the process of the audience’s involvement in the interactive narrative and its possible impact on suspense perception, as well as how the degree of suspense perceived in the story can be influenced by the interactive mode of the story through manipulating the choice. For the empirical research, quantitative methodology has been employed and one hundred and forty two participants took part in three experiments where they were asked to read and re-read non-interactive and interactive versions of a story created on the base of James Bond novels. The core data was collected from self-reports and surveys that the participants were asked to complete during and after experiments. Additional data came from the participants’ comments on their experience during the experiments. This thesis makes two main contributions to the study of interactive narrative and narrative-based video games. First, it empirically proves that choice does not reduce the level of perceived suspense in the interactive story as it has been argued by some scholars (i.e. Frome & Smuts, 2004). . Second, the results of the research suggest that by manipulating the choice offered to the audience it is possible to keep the level of suspense higher with repeated encounters. In addition, some other findings obtained from the experiments present factors that may influence suspense perception in interactive narrative such as the gender of the audience members, their gaming experience, and level of immersion in the story.</p>

Standardization of rounds on a general paediatric ward: Implementation of a checklist to improve efficiency, quality of rounds, and family satisfaction

Objective The purpose of this study was to develop a standardized rounding tool for use on the general paediatric ward and to determine if its use can improve quality of rounds as well as patient and parent satisfaction. Methodology The study used a pre- and post-intervention prospective observational methodology. The intervention consisted of the implementation of a Checklist Rounding Tool (CRT) entitled the ‘Paediatric Inpatient Rounding Checklist (PIRC)’ which outlined items deemed essential to discuss during rounds for all patients admitted to the paediatric ward. The PIRC was created by the research team after reviewing the literature and it was peer reviewed by a panel of expert paediatricians. Performance on rounds based on discussion of checklist items as well as patient and parent satisfaction were evaluated by an external observer both pre- and post-PIRC implementation. Results Four of the five less frequently addressed checklist items were discussed significantly more post-intervention. The Rounds Quality Score was significantly improved after checklist implementation, the pre- and post-intervention scores being 8.24 and 9.61/10, respectively (P-value &lt;0.001). Patient and parent satisfaction were rated higher with the use of the checklist. There was no difference in the duration of rounds between the pre- and post-implementation phases. Conclusion In summary, utilization of a standardized rounding tool on an inpatient paediatric ward led to improvement in quality of rounds as well as patient and parent satisfaction.

Radiating composite stars with electromagnetic fields

We derive the junction conditions for a general spherically symmetric radiating star with an electromagnetic field across a comoving surface. The interior consists of a charged composite field containing barotropic matter, a null dust and a null string fluid. The exterior atmosphere is described by the generalised Vaidya spacetime. We generate the boundary condition at the stellar surface showing that the pressure is determined by the interior heat flux, anisotropy, null density, charge distribution and the exterior null string density. A new physical feature that arises in our analysis is that the surface pressure depends on the internal charge distribution for generalised Vaidya spacetimes. It is only in the special case of charged Vaidya spacetimes that the matching interior charge distribution is equal to the exterior charge at the surface as measured by an external observer. Previous treatments, for neutral matter and charged matter, arise as special cases in our treatment of composite matter.

Efficacy of a Single Dose of Pregabalin on Signs of Anxiety in Cats During Transportation—A Pilot Study

Objectives: The aim of this clinical pilot study was to evaluate the dosage, efficacy, and clinical safety of a single oral dose of pregabalin in cats that experience fear and anxiety when placed into a carrier and transported by car.Methods: Thirteen client-owned cats were enrolled in a blinded, randomized, crossover study with three treatment days approximately 1 week apart. The cats were assigned to receive pregabalin oral solution at dosages of 5 and 10 mg/kg and placebo in a randomized order, one treatment per week. Treatment was administered ~90 min before placing the cat into a carrier and starting transportation. Efficacy was assessed by the owners using a categorical scale and, based on video recordings, by an external observer, both blinded to the treatment.Results: Owners assessed that cats given pregabalin displayed less vocalization, restlessness, and panting during transportation than did cats given placebo. Correlation between owners' and external observer's assessment of the overall treatment effect was good (0.63, p &lt; 0.01), which confirms the owners' ability to observe reliably their own cat's behavior. Transient mild ataxia was the most common adverse event reported. The human commercial formulation used in this study was found difficult or very difficult to administer by 79% of the owners.Conclusions and Relevance: Based on results of this pilot study, a single oral dose of pregabalin was well tolerated and decreased signs of anxiety and fear associated with car transportation in cats, as evaluated by blinded owners and external observer. The use of pregabalin prior to traveling may improve cat welfare and compliance for transportation. Further studies are needed to investigate the use of oral pregabalin in cats to alleviate signs of anxiety and fear associated with transportation and sequelae, like veterinary visits, and to develop a more user-friendly formulation.

Does the present moment depend on the moments not lived?

Integrated Information Theory postulates that a conscious experience depends on a repertoire of hypothetical experiences (the axiom of information). This makes consciousness depend on the context that constrains the set of possibilities and on the scenarios imagined by the external observer, and not only on the system itself.

Uncertainty Spillovers for Markets and Policy

We live in a world filled with uncertainty. In this essay, I show that featuring this phenomenon more in economic analyses adds to our understanding of how financial markets work and how best to design prudent economic policy. This essay explores methods that allow for a broader conceptualization of uncertainty than is typical in economic investigations. These methods draw on insights from decision theory to engage in uncertainty quantification and sensitivity analysis. Uncertainty quantification in economics differs from uncertainty quantification in most sciences because there is uncertainty from the perspective both of an external observer and of people and enterprises within the model. I illustrate these methods in two example economies in which the understanding of long-term growth is limited. One example looks at uncertainty ramifications for fluctuations in financial markets, and the other considers the prudent design of policy when the quantitative magnitude of climate change and its impact on economic opportunities are unknown.

Time-Delay Identification Using Multiscale Ordinal Quantifiers

Time-delayed interactions naturally appear in a multitude of real-world systems due to the finite propagation speed of physical quantities. Often, the time scales of the interactions are unknown to an external observer and need to be inferred from time series of observed data. We explore, in this work, the properties of several ordinal-based quantifiers for the identification of time-delays from time series. To that end, we generate artificial time series of stochastic and deterministic time-delay models. We find that the presence of a nonlinearity in the generating model has consequences for the distribution of ordinal patterns and, consequently, on the delay-identification qualities of the quantifiers. Here, we put forward a novel ordinal-based quantifier that is particularly sensitive to nonlinearities in the generating model and compare it with previously-defined quantifiers. We conclude from our analysis on artificially generated data that the proper identification of the presence of a time-delay and its precise value from time series benefits from the complementary use of ordinal-based quantifiers and the standard autocorrelation function. We further validate these tools with a practical example on real-world data originating from the North Atlantic Oscillation weather phenomenon.