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Outsourced Radiologists Perform Better Readings for Fewer Hospitals

By MedImaging International staff writers
Posted on 21 Jan 2013

Familiarity and experience working for a specific hospital matters when it comes to the performance of radiologists who work for outsourcing teleradiology companies, according to a group of researchers, whose recent findings could have significant consequences, given the growing use of telemedicine.

“More than half of all hospitals now use teleradiology services,” said Dr. Jonathan Clark, assistant professor of health policy and administration, Pennsylvania State University (Penn State; University Park, USA). “Hospitals send their X-ray, CT [computed tomography] scans, MRIs [magnetic resonance imaging], and other images to outsourcing companies who then forward the images to individual radiologists. Over the course of time, these radiologists gain a tremendous amount of experience by reading images from hundreds, or in some cases thousands, of customers.”

But is the experience gained by reading images for so many hospitals the same as the experience gained by repeatedly reading images for just a few hospitals? “There is debate out there about whether or not we should be outsourcing this kind of work,” Dr. Clark stated. “Some say that one CT is the same as another, so it doesn’t really matter if the CT is coming from hospital A or hospital B; what matters is that the person reading the image has the right training and experience. The other side of the debate says that radiological images are not commodities and that the process is more nuanced than simply exchanging bits of information over the information superhighway. From this perspective a radiologist’s performance will improve as he or she learns the nuances of reading images from a particular hospital.”

To figure out whether learning and performance improvement are customer-specific, the researchers, who also included Robert Huckman of the Harvard Business School (Cambridge, MA, USA) and Bradley Staats of the University of North Carolina at Chapel Hill (USA), studied the experience and productivity of 97 radiologists reading more than 2.7 million images from 1,431 hospitals.

“By estimating learning curves, we were able to determine the extent to which a radiologist's productivity reading an image for hospital A was a function of his or her prior experience reading for hospital A, versus his or her prior experience reading the same image for other hospitals,” Dr. Clark said.

The investigators discovered that the radiologist’s earlier experience with an ordering customer has a greater effect on performance than his or her overall experience reading the same type of image for other customers. “Somebody might look at that finding and say either what we should have is outsourcing radiologists who read for only a few customers or we shouldn’t have outsourcing at all,” Dr. Clark said, “because if you’re going to focus a radiologist on one or two customers, then you might as well make the argument that you should have him or her work as an employee for that customer.”

The researchers also found that the customer-specific knowledge gained by individual radiologists is aided by the variety of customers with whom a radiologist has experience. “How can it be that both specialization and variety are important?” Dr. Clark queried. “Our models can only take us so far toward answering this question, but we think the implication is that there are limits to both customer specialization and customer variety, and that the optimum is to have a nice mix of both specialized experience and variety in customers.”

Moreover, the researchers found that the customer specificity of learning lessened as the outsourcing company gained more experience with a particular customer. “The implication is that customer-specific capabilities may also be built at the level of the outsourcing organization as a whole and not just at the level of the individual radiologist,” Dr. Clark said. “Overall, this finding suggests that while there is customer specificity to learning for outsourcing radiologists, the implication is not that we shouldn’t outsource. Rather, our findings provide guidance to outsourcers in terms of how they might think about designing the work of their radiologists to maximize productivity. For new customers, an outsourcing firm may wish to keep individual providers relatively more focused on serving a specific customer. As organizational experience accrues with a specific customer, however, such dedication becomes less critical.”

The results of the study findings appeared online in January 8, 2013, in the journal Organization Science. “Our findings may be particularly important, given the growing use of telemedicine and the uncertainty associated with delivering healthcare in a virtual way. In the setting we studied, teleradiologists are often reading emergency cases, where speed and productivity can be critical, so it is important for outsourcing radiology firms to understand how they might design their operations to improve performance and ensure a rapid response for each customer,” concluded Dr. Clark.

Related Links:
Pennsylvania State University
Harvard Business School
University of North Carolina at Chapel Hill

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62 (616.07360839844): SELECT fid FROM jos_deeppockets WHERE id=294744342 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744342 AND published='1' LIMIT 1

63 (406.02684020996): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

64 (83.92333984375): select jos_twitters.link from jos_twitters where cat=10

65 (43.153762817383): select jos_facebook.link from jos_facebook where cat=10

66 (46.968460083008): select jos_google_plus.link from jos_google_plus where cat=10

67 (42.915344238281): select jos_linkedin.link from jos_linkedin where cat=10

68 (61.988830566406): SELECT fid FROM jos_deeppockets WHERE id=294744342 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744342 AND published='1' LIMIT 1

69 (51.021575927734): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (511.88468933105): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744342 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (365.01884460449): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744342 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (50.067901611328): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (115.87142944336): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (77.009201049805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744342 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (44.107437133789): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744342 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (37.908554077148): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (69.856643676758): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (54.836273193359): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (109.19570922852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

105 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

106 (84.877014160156): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294744342 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (118.01719665527): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294744342 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (116.82510375977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

109 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

110 (69.856643676758): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294744342 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (716.9246673584): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294744342 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (787.97340393066): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (593.18542480469): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (136.8522644043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

115 (55.789947509766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

116 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

117 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

118 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

119 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

120 (289.9169921875): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 21189.92805481): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

123 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

124 (488.9965057373): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744342 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744342 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 641853.09410095): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (92.983245849609): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (111.10305786133): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (32.901763916016): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (58.889389038086): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (38.14697265625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (485.89706420898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (540.01808166504): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (276.08871459961): SELECT name FROM jos_deeppockets WHERE id=211

136 (36.954879760742): SELECT name FROM jos_deeppockets WHERE id=211

137 (637.05444335938): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (571.96617126465): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (105.85784912109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

140 (104.90417480469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

141 (!!!!! 12190.103530884): TRUNCATE TABLE jos_trademed_module

142 (97.036361694336): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294744342 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (60.081481933594): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294744342 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (665.90309143066): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

147 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

148 (!!!!! 1554.9659729004): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

150 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

151 (92.029571533203): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744342 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744342 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (45.7763671875): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

153 (41.007995605469): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

154 (56.028366088867): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (202.89421081543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

156 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744342 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744342 AND published='1' LIMIT 1

157 (39.815902709961): select jos_twitters.link from jos_twitters where cat=10

158 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

159 (41.007995605469): select jos_google_plus.link from jos_google_plus where cat=10

160 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

161 (!!!!! 1046.895980835): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1598.1197357178): insert into jos_banners_delta values (14615,'2025-06-20 12:09:38','216.73.216.120','view'),(14202,'2025-06-20 12:09:38','216.73.216.120','view'),(14203,'2025-06-20 12:09:38','216.73.216.120','view')

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