Ultrahypofractionation in postoperative radiotherapy for breast cancer: A single-institution retrospective cohort series.

BACKGROUND: The 'FAST-forward', study published in April 2020, demonstrated the effectiveness of an extremely hypofractionated radiotherapy schedule, delivering the total radiation dose in five sessions over the course of 1 week. We share our department's experience regarding patients treated with this regimen in real-world clinical settings, detailing outcomes related to short-term toxicity and efficacy. METHODS: A descriptive observational study was conducted on 160 patients diagnosed with breast cancer. Between July 2020 and December 2021, patients underwent conservative surgery followed by a regimen of 26 Gy administered in five daily fractions. RESULTS: The median age was 64 years (range: 43-83), with 82 patients (51.3%) treated for left-sided breast cancer, 77 patients (48.1%) for right-sided breast cancer, and 1 instance (0.6%) of bilateral breast cancer. Of these, 66 patients had pT1c (41.3%), 70.6% were infiltrative ductal carcinomas, and 11.3% were ductal carcinoma in situ. Most tumours exhibited intermediate grade (41.9%), were hormone receptor positive (81.3%), had low Ki-67 (Ki-67 < 20%; 51.9%) and were Her 2 negative (85%). The majority of surgical margins were negative (99.4%). Among the patients, 72.5% received hormonotherapy, and 23.8% received chemotherapy. Additionally, 26 patients (16.3%) received an additional tumour boost following whole breast irradiation (WHBI) of 10 Gy administered in five sessions of 2 Gy over a week. The median planning target volume (PTV) was 899 cm3 (range: 110-2509 cm3). Early toxicity was primarily grade I radiodermatitis, affecting 117 patients (73.1%). During a median follow-up of 15 months (range: 3.9-28.77), only one patient experienced a local relapse, which required mastectomy. CONCLUSIONS: The implementation of this highly hypofractionated regimen in early-stage breast cancer appears feasible and demonstrates minimal early toxicity. However, a more extended follow-up duration would be required to evaluate long-term toxicity and efficacy accurately.

Design and test of novel scent enrichments to enhance breeding of zoo-housed lemurs.

Background: Zoos use environmental enrichments, including scents, which may have applications to improve breeding success for taxa, such as lemurs, which rely heavily on olfactory communication. We aimed to develop novel, biologically-relevant scent enrichments to trigger mating behaviours of zoo-housed lemur species, which are critically endangered in the wild and show a low success rate in captive breeding programmes. Methods: We examined anogenital odour secretions, released by female gentle ( Hapalemur alaotrensis) and ruffed ( Varecia variegata) lemurs, using solid-phase microextraction and gas chromatography-mass spectrometry techniques. We identified the key compounds distinguishing the volatile chemical profile of female lemurs during the breeding season and used them to develop species-specific scent enrichments. We then tested the scent enrichments, made up of synthesized mixtures conveying information about female lemur fertility, on unsuccessful breeding pairs of lemurs hosted in European zoos. We evaluated the effects of the newly designed scent enrichments on their target species by combining behavioural observations with faecal endocrinology. Results: We identified and reproduced fertility-specific signals associated with female scents. These scent mixtures triggered male sexual behaviours, including mating, during and after the enrichment condition. We also found effects on faecal testosterone levels, with increased levels after the enrichment condition albeit not statistically significant. Conclusions: Our findings suggest that biologically-relevant scent enrichments may trigger natural species-specific behaviours, with potential implications for conservation breeding of zoo-based endangered lemur species, and highlight that combining more assessment methods may assist with evaluating the impact of environmental enrichments.

CREST-UK: Real-world effectiveness, safety and outpatient delivery of CPX-351 for first-line treatment of newly diagnosed therapy-related AML and AML with myelodysplasia-related changes in the UK.

Favourable outcomes with CPX-351 versus conventional 7 + 3 were demonstrated in the pivotal phase III trial in adults aged 60-75 years with newly diagnosed, highrisk/secondary acute myeloid leukaemia (AML). As a complement to the clinical trial and to address important data gaps, the CPX-351 Real-World Effectiveness and SafeTy (CREST-UK; NCT05169307) study evaluated the use of CPX-351 in routine clinical practice in the UK, in 147 patients with newly diagnosed therapy-related AML or AML with myelodysplasia-related changes. Best response of complete remission or complete remission with incomplete platelet or neutrophil recovery was achieved by 53% of evaluable patients. Kaplan-Meier median overall survival (OS) was 12.8 months (95% confidence interval 9.2-15.3). Fifty (34%) patients proceeded to haematopoietic cell transplantation (HCT); median OS landmarked from the HCT date was not reached. There were no new safety concerns with CPX-351 identified in CREST-UK. Patients treated with CPX-351 in the outpatient setting spent an average of 24.4, 16.7, 28.2, and 27.7 fewer days on the ward compared with inpatients during first induction, second induction, first consolidation, and second consolidation, respectively. The results from CREST-UK provide valuable insights into the effectiveness, safety, and outpatient delivery of CPX-351 in routine clinical practice in the UK.

Association Between Atopic Dermatitis and Aging: Clinical Observations and Underlying Mechanisms.

As one of the most prevalent chronic inflammatory skin diseases, atopic dermatitis (AD) increasingly affects the aging population. Amid the ongoing global aging trend, it's essential to recognize the intricate relationship between AD and aging. This paper reviews existing knowledge, summarizing clinical observations of associations between AD and aging-related diseases in various systems, including endocrine, cardiovascular, and neurological. Additionally, it discusses major theories explaining the correlation, encompassing skin-mucosal barriers, systemic inflammation and stress, genes, signal transduction, and environmental and behavioral factors. The association between AD and aging holds significant importance, both in population and basic perspectives. While further research is warranted, this paper aims to inspire deeper exploration of inflammation/allergy-aging dynamics and the timely management of elderly patients with AD.

An approach for estimating microbial growth and chlorinated ethenes biotransformation in groundwater based on discrete observations.

The bioremediation of chlorinated ethenes (CEs) contaminated groundwater is attracting increasingly attention in practical remediation projects. However, modelling of microbial metabolic processes under the constraints of substrate and environmental factors is inadequate. This study developed a new kinetic model, which incorporated the logistic model and Dual-Monod kinetic to represent the interaction between the controlled microbial growth and the bioavailable substrates in CE-contaminated groundwater. The proposed model was based on discrete observations to simulate microbial growth under the constraints of substrate and environmental conditions, reducing the amount of observational data required for the model. Meanwhile, the proposed model introduced two new kinetic parameters, the effective specific growth rate µeff and the real self-limiting coefficient of microbial growth keff,sl, to simplified the number of independent parameters. A parameter estimation method based on the quasi-Newton's algorithm for the proposed model was also developed. The model was validated based on the hypothetical data, experimental results, and a published dataset, demonstrated the successful simulation of microbial growth and the sequential biodegradation of PCE in groundwater systems (*E < 0.3). The monitoring duration and the sampling schedule have significant impacts on estimating the biological parameters, and large errors would be induced when the data from the periods of extremely low substrate concentration or microbial growth decline were involved in parameter estimation. The research suggested that the proposed kinetic model provided a new insight to express the limitation of microbial population growth due to the available substrates and environmental factors, and is hoping to be applied in actual CE-contaminated sites.

Subsidence Characteristics in North Anhui Coal Mining Areas Using Space-Air-Ground Collaborative Observations.

To fully comprehend the patterns of land and ecological damage caused by coal mining subsidence, and to scientifically carry out ecological mine restoration and management, it is urgent to accurately grasp the information of coal mining, particularly in complex coaling areas, such as North Anhui, China. In this paper, a space-air-ground collaborative monitoring system was constructed for coal mining areas based on multi-source remote sensing data and subsidence characteristics of coaling areas were investigated in North Anhui. It was found that from 2019 to 2022, 16 new coal mining subsidence areas were found in northern Anhui, with the total area increasing by 8.1%. In terms of land use, water areas were increased by 101.9 km2 from 2012 to 2022, cultivated land was decreased by 99.3 km2, and residence land was decreased by 11.8 km2. The depth of land subsidence in the subsidence areas is divided into 307.9 km2 of light subsidence areas with a subsidence depth of less than 500 mm; 161.8 km2 of medium subsidence areas with a subsidence depth between 500 mm and 1500 mm; and 281.2 km2 of heavy subsidence areas with a subsidence depth greater than 1500 mm. The total subsidence governance area is 191.2 km2, accounting for 26.5% of the total subsidence area. From the perspective of prefecture-level cities, the governance rate reaches 51.3% in Huaibei, 10.1% in Huainan, and 13.6% in Fuyang. The total reclamation area is 68.8 km2, accounting for 34.5% of the subsidence governance area. At present, 276.1 km2 within the subsidence area has reached stable subsidence conditions, mainly distributed in the Huaibei mining area, which accounts for about 60% of the total stable subsidence area.

Exploring virtual funding committee practices in the allocation of National Institute for Health and Care Research funding: A netnographic study.

Background: Funding committees, comprising members with a range of knowledge, skills, and experience, are considered integral to the decision-making process of funding organisations for recommending or allocating research funding. However, there is limited research investigating the decision-making processes, the role of members and their social interactions during funding committee meetings conducted both virtually and face-to-face. Methods: Using a mixed-methods design and following netnography principles, the study observed nine National Institute for Health and Care Research programmes funding committee meetings conducted virtually during October 2020 to December 2021; complemented by interviews with committee chairs and members (18 interviews) and NIHR staff (12 interviews); an online survey (50 responses); and documentary analysis. Personal reflections through immersive journals also formed part of the analysis. Results: Three main themes were identified from the observations, interviews, and online survey: efficiency of virtual committee meetings (importance of preparation, and the role of formality, process, and structure); understanding the effect of virtual committee meetings on well-being (effects of fatigue and apprehension, and the importance of work life balance); understanding social interactions and engagement (levels of engagement, contribution and inclusivity, awareness of unconscious bias and the value of social networking). Conclusions: Examining the decision-making practices of one funding organisation across several research programmes, across multiple committee meetings over one year has generated new insights around funding committee practices that previous studies have not been able to explore or investigate. Overall, it was observed that fair and transparent funding recommendations and outcomes can be achieved through virtual funding committees. However, whilst virtual funding committees have many benefits and opportunities, such as the potential to increase membership diversity and inclusivity, and be more environmentally sustainable, more evidence is needed to evaluate their effectiveness, with particular focus on issues of fatigue, engagement, and committee cohesion, especially when new committee members join.

Inversion of Critical Atmospheric 137Cs Emissions Following the Fukushima Accident by Resolving Temporal Formation from Total Deposition Data.

Understanding the transport of 137Cs emitted during the Fukushima accident is challenging because the critical emissions that produced the high-deposition area are not adequately resolved in existing source terms. This paper presents an objective inverse reconstruction of these emissions by fusing atmospheric concentrations with a-priori emissions extracted from total depositions. This extraction, previously considered impossible for complex real-world accidents, is achieved by identifying the critical temporal formation process of depositions in the high-deposition area and estimating the corresponding emissions by using an atmospheric transport model. The reconstructed source term reveals two emission peaks from 10:00-11:00 and 14:00-15:00 on March 15, which agree with the in situ pressure measurements and accident analysis, suggesting that they came from pressure drops in the primary containment vessels of Units 3 and 2, respectively. This finding explains the environmental observations of spherical 137Cs particles. The source term also objectively and independently confirms the widely used reverse estimate. The corresponding 137Cs transport simulations better match the various observations than those produced by other source terms, proving that the two-peak emission creates a high-deposition area. The proposed method outperforms the direct fusion of deposition and atmospheric concentration observations, providing a robust tool for multiobservation fusion.

Sources and formation characteristics of particulate nitrate in the Pearl River Delta region of China: Insights from three-year online observations.

Nitrate (NO3-) has been identified as a key component of particulate matter (PM2.5) in China. However, there is still a lack of understanding regarding its sources and how it forms, especially in the context of high-frequency and long-term data. In this study, NO3- levels were observed on an hourly basis over an almost three-year period at an urban site in the Pearl River Delta (PRD) region, China, from January 2019 to December 2021. The results reveal an average daily NO3- concentration ranging from 0.08 µg m-3 to 61.69 µg m-3, constituting 11.9 ± 12.5 % of PM2.5. This percentage rose to as high as 57 % during pollution episodes, highlighting NO3-'s significant role in pollution formation. The ammonia-rich environment was found to be the most important factor in promoting NO3- formation. Positive Matrix Factorization (PMF) analysis indicates that the primary sources of NO3- in the PRD region were vehicle emissions (43.8 ± 21.2 %) and coal combustion (39.1 ± 21.5 %), with shipping emissions, sea salt, soil dust and industrial emissions + biomass burning following in importance. Regarding source areas, the primary contributor of vehicle emissions was predominantly from the PRD region, whereas the coal combustion, aside from local contributions, also originates from the northern region. From a long-term perspective, NO3- pollution has remained relatively stable since the summer of 2020. Concurrently, coal combustion source has shown a localization trend. These insights derived from the extensive, high-frequency observation presented in this study serve as a valuable reference for devising strategies to control NO3- and PM2.5 in the PRD region and China.

Project PRIME: road markings for motorcycle casualty reduction (an overview of findings from 2020 to 2022).

Pioneering road markings for motorcyclists, designed as Perceptual Rider Information for Maximising Expertise and Enjoyment (PRIMEs) were installed on approach to demanding bends at 22 trial sites and two comparison sites across the West Highlands of Scotland. The markings provided a series of 'gateways' to encourage safer riding. With 32,213 motorcyclists observed, the following statistically significant results were observed: speed reductions at 10 trial sites; positive changes in lateral position at the final PRIME gateway marking at 15 trial sites and positive changes in lateral position at the apex of the bend at 13 trial sites; reductions in braking at nine trial sites; increases use of PRIME road markings across 18 of the 22 trial sites. No statistically significant effects were observed at the comparison sites. These findings are discussed in relation to the 'Road Safety Framework to 2030' and the 'Safe System' approach to reducing motorcycle casualties.

This world-first research presents the largest investigation of rider behaviour involving 32,213 motorcyclists. Pioneering road markings for motorcyclists produced statistically significant positive behavioural changes in speed, lateral lane position and braking. This work identifies important behavioural factors that support the 'Safe System' approach to motorcycle casualty reduction.

Study methodology impacts density-dependent dispersal observations: a systematic review.

The relationship between animal dispersal and conspecific density has been explored in various study systems but results in terms of both the magnitude and the direction of density dependence are inconsistent. We conducted a thorough review of the literature (2000-2023) and found k = 97 empirical studies of birds, fishes, herpetofauna (amphibians and reptiles), invertebrates, or mammals that had tested for a correlation between conspecific density and animal dispersal. We extracted categorical variables for taxonomic group, sex, age, migratory behavior, study design, dispersal metric, density metric and variable type, as well as temporal and spatial scale, to test each of their correlation with the effect of density on dispersal (Pearson's r) using linear regressions and multilevel mixed-effect modelling. We found certain biases in the published literature, highlighting that the impact of conspecific density on dispersal is not as widespread as it is thought to be. We also found no predominant trend for density-dependent dispersal across taxonomic groups. Instead, results show that the scale and metrics of empirical observations significantly affected analytical results, and heterogeneity measures were high within taxonomic groups. Therefore, the direction and magnitude of the interaction between density and dispersal in empirical studies could partially be attributed to the data collection method involved. We suggest that the contradictory observations for density-dependent dispersal could be explained by dispersal-dependent density, where density is driven by movement instead, and urge researchers to either test this interaction when applicable or consider this perspective when reporting results.

Student Observations Reveal Gaps Between Chest Imaging Theory and Practice.

PURPOSE: To assess whether first-year radiography students observed differences between what they were taught in didactic and laboratory courses and how technologists perform chest imaging procedures during clinical experiences. METHODS: This study used a mixed-methods approach with a cross-sectional survey, consisting of 11 quantitative and 11 qualitative items, during the fall 2020 semester. The survey asked participants to evaluate survey statements based on their observations of radiographers' behaviors during chest imaging procedures in relation to the 11 American Registry of Radiologic Technologist clinical competency areas. Participants rated their evaluations based on the degree to which they agreed or disagreed with statements regarding radiographers' behaviors using a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). For each statement, a follow-up, open-ended question asked participants to provide reasons why they thought technologists did or did not exhibit certain behaviors. Data were analyzed quantitatively with differential statistics and qualitatively by thematically categorizing open-ended responses. RESULTS: A total of 19 first-year radiography students (N = 19) completed the survey. Most participants somewhat agreed or strongly agreed with 8 out of the 11 competency statements based on their observations of technologists when performing chest imaging procedures: room preparation (73.7%), patient identity verification (89.5%), examination order verification (79%), patient assessment (79%), equipment operation (52.6%), patient management (100%), technique selection (73.6%), and image evaluation (94.7%). Most participants somewhat disagreed, strongly disagreed, or were neutral with 3 out of the 11 categories: patient positioning, radiation safety, and image processing. Qualitatively, participants responded that technologists only provided lead shielding for pediatric patients, were not instructing patients to take 2 inspirations before making an exposure, and were cropping their images electronically before submitting them for diagnoses. DISCUSSION: Participants reported inconsistencies between what they were taught and what they saw technologists doing during chest imaging procedures related to patient positioning, radiation safety, and imaging processing. Participants' responses stated that these inconsistencies might be because of an increase in technologist responsibilities, patient volumes, and fear of not including relative anatomy on their images. CONCLUSION: Participants reported the most disagreement with radiation safety during chest imaging procedures. Although lead shielding for abdominal and pelvic procedures is no longer recommended, shielding patients during chest imaging procedures is still recommended. Radiography programs can educate students that inconsistency between task order does not mean there is a gap between theory and practice.

Wildfire risk management in the era of climate change.

The August 8, 2023R Lahaina fire refocused attention on wildfires, public alerts, and emergency management. Wildfire risk is on the rise, precipitated through a combination of climate change, increased development in the wildland-urban interface (WUI), decades of unmitigated biomass accumulation in forests, and a long history of emphasis on fire suppression over hazard mitigation. Stemming the tide of wildfire death and destruction will involve bringing together diverse scientific disciplines into policy. Renewed emphasis is needed on emergency alerts and community evacuations. Land management strategies need to account for the impact of climate change and hazard mitigation on forest ecosystems. Here, we propose a long-term strategy consisting of integrating wildfire risk management in wider-scope forest land management policies and strategies, and we discuss new technologies and possible scientific breakthroughs.

Landscape-Scale Biodiversity Impacts Analysis of Côte d'Ivoire's Cocoa Cultivation along Export Supply Chains.

Agricultural land use for export commodities leads to significant biodiversity impacts. A spatially detailed assessment of these impacts is crucial for implementing effective mitigation policies. Using cocoa cultivation and exports in Côte d'Ivoire as an example, we present a novel framework that combines earth observations, enhanced landscape-scale biodiversity models, and subnational export supply chain data sets to track the tele-connected potential biodiversity impacts of export groups and importing countries. We found that cocoa cultivation accounts for ∼44% of the biodiversity impacts in Côte d'Ivoire's cocoa cultivation areas, with >90% attributable to cocoa exports. The top 10 importing countries account for ∼84% of these impacts. Our method offers improved spatial detail compared to the existing approaches, facilitating the identification of biodiversity impact hotspots. Additionally, the biodiversity impacts of agroforestry cocoa are not always lower compared to full-sun cocoa, especially when agroforestry systems are established in regions of high biodiversity importance. Our transferable framework provides a comprehensive understanding of biodiversity footprint and promotes informed decision-making for sustainable agricultural production, processing, and trade. Our framework's application is currently constrained by the scarcity of detailed supply chain data sets; we underscore the urgent need for improved supply chain transparency to fully unlock the framework's potential.

Assessing the prevailing driver seatbelt compliance at Madina Zongo junction in Accra, Ghana: An observational study.

OBJECTIVE: This study aimed to examine the prevailing driver seatbelt compliance at the Madina Zongo junction in Accra, Ghana. METHODS: An unobtrusive observational survey was conducted from 6 to 8 am and 5 to 7 pm on weekdays at randomly designated locations near the junction. A total of 3,054 vehicles were observed throughout the observation period. The data collected were analyzed with SPSS version 26. Cross-tabulations and Pearson's Chi-square test were employed for thorough analysis. RESULTS: The study revealed an overall seatbelt compliance rate of slightly over half (54.1%) among drivers, with the following breakdowns in various vehicle categories: large buses (76.2%), medium buses (98.1%), minibuses (44.0%), private cars (70.5%), taxi/uber (53.0%), and trucks (41.1%). Notably, seatbelt compliance was higher among females at 98.4%, compared to males at 49.2%. The study also identified a correlation between driver's gender and vehicle type with seatbelt compliance. Conversely, no significant association was found between seatbelt compliance and either the time of day or day of the week. CONCLUSIONS: The study offers significant findings regarding seatbelt usage trends at the Madina Zongo junction in Accra. These insights provide a basis for recommending targeted interventions such as policy decisions, public health campaigns, communication strategies, better enforcement, and road safety training programs. These interventions aim to raise awareness of unsafe attitudes and behaviors among drivers to improve seatbelt compliance and ultimately enhance road safety for all road users.

Automated Observations of Dogs' Resting Behaviour Patterns Using Artificial Intelligence and Their Similarity to Behavioural Observations.

Although direct behavioural observations are widely used, they are time-consuming, prone to error, require knowledge of the observed species, and depend on intra/inter-observer consistency. As a result, they pose challenges to the reliability and repeatability of studies. Automated video analysis is becoming popular for behavioural observations. Sleep is a biological metric that has the potential to become a reliable broad-spectrum metric that can indicate the quality of life and understanding sleep patterns can contribute to identifying and addressing potential welfare concerns, such as stress, discomfort, or health issues, thus promoting the overall welfare of animals; however, due to the laborious process of quantifying sleep patterns, it has been overlooked in animal welfare research. This study presents a system comparing convolutional neural networks (CNNs) with direct behavioural observation methods for the same data to detect and quantify dogs' sleeping patterns. A total of 13,688 videos were used to develop and train the model to quantify sleep duration and sleep fragmentation in dogs. To evaluate its similarity to the direct behavioural observations made by a single human observer, 6000 previously unseen frames were used. The system successfully classified 5430 frames, scoring a similarity rate of 89% when compared to the manually recorded observations. There was no significant difference in the percentage of time observed between the system and the human observer (p > 0.05). However, a significant difference was found in total sleep time recorded, where the automated system captured more hours than the observer (p < 0.05). This highlights the potential of using a CNN-based system to study animal welfare and behaviour research.

Identifying predictors of COVID-related delays in cancer-specific medical care.

PURPOSE: Evidence of the impact of the COVID-19 pandemic on cancer prevention and control is growing, but little is known about patient-level factors associated with delayed care. We analyzed data from a survey focused on Iowan cancer patients' COVID-19 experiences in the early part of the pandemic. METHODS: Participants were recruited from the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden (PERCH) program. We surveyed respondents on demographic characteristics, COVID-19 experiences and reactions, and delays in any cancer-related health care appointment, or cancer-related treatment appointments. Two-sided significance tests assessed differences in COVID-19 experiences and reactions between those who experienced delays and those who did not. RESULTS: There were 780 respondents (26% response), with breast, prostate, kidney, skin, and colorectal cancers representing the majority of respondents. Delays in cancer care were reported by 29% of respondents. In multivariable-adjusted models, rural residents (OR 1.47; 95% CI 1.03, 2.11) and those experiencing feelings of isolation (OR 2.18; 95% CI 1.37, 3.47) were more likely to report any delay, where experiencing financial difficulties predicted delays in treatment appointments (OR 5.72; 95% CI 1.96, 16.67). Health insurance coverage and concern about the pandemic were not statistically significantly associated with delays. CONCLUSION: These findings may inform cancer care delivery during periods of instability when treatment may be disrupted by informing clinicians about concerns that patients have during the treatment process. Future research should assess whether delays in cancer care impact long-term cancer outcomes and whether delays exacerbate existing disparities in cancer outcomes.

New shark in the park: Tiger shark Galeocerdo cuvier observations in the remote South Pacific.

We present the first photographic records of the tiger shark (Galeocerdo cuvier) at the remote Rapa Nui (Easter Island) in the south-east Pacific. Previous anecdotal sightings exist for tiger sharks in this region; however these records have not been reported within the scientific domain. The present sighting occurred in a period of unusually warm sea surface temperature, which has been shown to influence tiger shark range extensions elsewhere. Novel and historic species occurrence records are valuable for determining and predicting species' environmental tolerances, migratory routes, and distributional limits.

How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study.

BACKGROUND: Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician's responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs. METHODS: An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021. RESULTS: In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians' work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks. CONCLUSION: In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.