The sorting effect in healthcare access: Those left behind

Many governments have sought to enhance patient choice in hospital by intensifying competitive pressure on hospital administrations that is expected to improve efficiency, quality, and innovation. However, there is mixed evidence on whether patients travel past their local hospitals to seek better quality care and whether higher-income patients are those most sensitive to respond to competitive pressures. Using detailed data from 17 million inpatient stays admitted in France during 2019, this paper explores patients' choice of provider where for-profit, non-profit, research hospital and local hospitals are allowed to compete with each other. We estimate the extent to which deprivation gradient plays on patient's choice of provider. We found that, in general, patients travel for their care, with just one-quarter of them going to the nearest hospital. In fact, the most vulnerable patients (i.e., those socio-economically deprived, and very aged) are mostly treated in local public hospitals with the lowest quality service level, and with large variability in quality as well, while those with less socio-economic deprivation seek care at higher-quality for-profit hospitals. Our counterfactual simulations show that admission to university hospitals attenuates existing inequalities. However, whether it delays the healthcare access sought by this population remains an open question.

Dissemination feature based on PET/CT is a risk factor for diffuse large B cell lymphoma patients outcome

BACKGROUND

18F-FDG PET/CT provides precise information about dissemination of lymphoma lesions. Dmax, defined as distance between the two lesions that were farthest apart by PET/CT, was found to be a promising predictor of Diffuse large B-cell lymphoma (DLBCL) outcome in a small size of clinical trial data. We analyzed the impact of Dmax on the outcome of a large real-world DLBCL cohort.

METHODS

Data of newly diagnosed DLBCL at the Third Affiliated Hospital of Soochow University were retrospectively collected. Baseline Dmax, clinical data and survival information were recorded. A metabolic parameter, metabolic bulk volume (MBV), was also measured to verify the independent impact of Dmax.

RESULTS

Optimal cut-off values for Dmax and MBV were 45.34 cm and 21.65 cm3. With a median follow-up of 32 months, Dmax significantly impacted progression-free survival (PFS) and overall survival (OS) in 253 DLBCL patients. For Dmaxlow and Dmaxhigh groups, estimated 3-year OS were 87.0% and 53.8% (p < 0.001), while 3-year PFS were 77.3% and 37.3% (p < 0.001). And for MBVlow and MBVhighgroups, 3-year OS were 84.5% and 58.8% (p < 0.001), and 3-year PFS were 68.7% and 50.4% (p = 0.003). Multivariate analysis identified Dmax and Eastern Cooperative Oncology Group performance status (ECOG PS) independently associated with PFS and OS, while MBV only independently associated with OS. A Dmax revised prognostic index (DRPI) combining Dmax and ECOG PS identified an ultra-risk DLBCL population with 3-year PFS of 31.7% and 3-year OS of 38.5%. The area under the curve (AUC) showed that this model performed better than International prognostic Index (IPI).

CONCLUSION

Dmax is a new and promising indicator to investigate dissemination of lymphoma lesions associated with the outcome of DLBCL. It significantly contributes to stratification of patients with disparate outcomes.

TRIAL REGISTRATION

This research has been retrospectively registered in the Ethics Committee institutional of the Third Affiliated Hospital of Soochow University, and the registration number was approval No. 155 (approved date: 31 May 2022).

Effectiveness of shielding materials against 177Lu gamma rays and the corresponding distance relationship

OBJECTIVE

The purpose of this study is to determine the dose reduction of different shielding materials at various distances from a 177Lu photon radiation source.

METHODS

Two protective aprons with lead equivalent thicknesses of 0.25 mm and 0.35 mm and tungsten-containing rubber (TCR) were used as shielding materials. A vial containing 177Lu was sealed in a lead container so that a narrow beam went out through a 3 mm-diameter hole. The dose rate was measured at distances of 0, 10, 50, 100, and 200 cm from the source using a NaI scintillation survey meter to obtain the rate of dose reduction. TCR was tested with thicknesses ranging from 0.3 to 1.0 mm at 0.1 mm intervals and from 1.0 to 4.0 mm at 0.5 mm intervals.

RESULTS

At distances of 0, 10, 50, 100, and 200 cm, the dose reduction for the lead equivalent thickness of 0.25 mm were 32.7%, 54.5%, 93.1%, 97.9%, and 99.6%, respectively; and for the lead equivalent thickness of 0.35 mm were 53.4%, 70.6%, 95.6%, 98.9%, and 99.6%, respectively. Without any shielding, the dose rate decreased by 34.4% at 10 cm and by 88.8% at 50 cm from the radiation source. The dose reduction for the TCR thickness of 3.5 mm was 89.8% at 0 cm and 93.3% at 10 cm. The TCR thickness of 0.4 mm provided a dose reduction comparable to or greater than that of the 0.25 mm lead equivalent, whereas the TCR thickness of 1.0 mm or greater provided a dose reduction comparable to that of the 0.35 mm lead equivalent.

CONCLUSIONS

Achieving a reduction of 95% or more requires the 0.25 mm lead equivalent for a distance of 100 cm, the 0.35 mm lead equivalent for 50 cm, the TCR thickness of 0.3 mm for 100 cm, or the TCR thickness of 0.9 mm for 50 cm. Without wearing a protective apron, a reduction of approximately 95% is observed at distances greater than 100 cm. These findings would be useful for medical staff engaging in related activities.

Boys Choirs in the Pandemic: Effects of Distance and Other Factors on Spectral and Temporal Accuracy

During the Covid-19 pandemic, choral singing has been either completely prohibited or regulated with safety measures due to increased transmission risks. However, the impact of larger inter-singer spacings on the performance and educational process in boys' choirs is unclear. This study analyzed recordings of six groups of five singers each from two boys' choirs aged 7-16 who sang Beethoven's Ode to Joy while standing on an arc with a 4 m radius and an inter-subject spacing of 0.5-3 m. The effects of singers' masks, distance, group age, and relative position on the timing of articulation and fundamental frequency were investigated, along with the amount, rate, and sign of pitch drift and loudness. The ANOCOVA results showed that onsets were robust to the tested factors, while errors in fundamental frequency tended to decrease with increasing age/experience. Loudness was affected by distance, mask, and relative position, with increasing loudness as spacing decreased. Understanding influencing factors can inform recommendations for choral singing and education.

The Geography of Injuries in Trauma Systems: Using Home as a Proxy for Incident Location

INTRODUCTION

Effective trauma system organization is crucial to timely access to care and requires accurate understanding of injury and resource locations. Many systems rely on home zip codes to evaluate geographic distribution of injury; however, few studies have evaluated the reliability of home as a proxy for incident location after injury.

METHODS

We analyzed data from a multicenter prospective cohort collected from 2017 to 2021. Injured patients with both home and incident zip codes were included. Outcomes included discordance and differential distance between home and incident zip code. Associations of discordance with patient characteristics were determined by logistic regression. We also assessed trauma center catchment areas based on home versus incident zip codes and variation regionally at each center.

RESULTS

Fifty thousand one hundred seventy-five patients were included in the analysis. Home and incident zip codes were discordant in 21,635 patients (43.1%). Injuries related to motor vehicles (aOR: 4.76 [95% CI 4.50-5.04]) and younger adults 16-64 (aOR: 2.46 [95% CI 2.28-2.65]) were most likely to be discordant. Additionally, as injury severity score increased, discordance increased. Trauma center catchment area differed up to two-thirds of zip codes when using home versus incident location. Discordance rate, discordant distance, and catchment area overlap between home and incident zip codes all varied significantly by geographic region.

CONCLUSIONS

Home location as proxy for injury location should be used with caution and may impact trauma system planning and policy, especially in certain populations. More accurate geolocation data are warranted to further optimize trauma system design.

Differential patient travel distance and time to psoriasis clinical trial sites

Considering the known disparities in racial representation in psoriasis clinical trials, this study sought to characterize travel distance and time to reach a psoriasis clinical trial site as a potential barrier to trial participation for multiple demographic and geographic variables. We determined travel distance and time from every census tract population center in the United States to the nearest psoriasis clinical trial site using ArcGIS and linked travel estimates to demographic characteristics in each census tract based on 2020 American Community Survey. The average distance and time traveled to reach a psoriasis clinical trial site nationally were 45.6 miles and 51.8 min, respectively. Urban residence and Northeast location had significantly lower travel distance and time relative to their geographic counterparts. Travel burden was significantly greater among Native American and Black races, individuals without college education and Veterans Affairs beneficiaries relative to their counterparts. These findings reveal disparate access regarding rurality, race, education and insurance type, which may encourage investigators to increase travel funding for underrepresented groups and diversity recruitment efforts to promote access to psoriasis clinical trials.

Direction and distance information in memory for location relative to landmarks

An object's location is often remembered relative to one or more landmarks. An object has a certain direction and distance relative to a landmark. When multiple landmarks are available the information from the different landmarks is integrated. In the prevailing view direction and distance are equally influential in the integration process. We present evidence that direction and distance are not always equally influential in landmark-based memory. During the study phase of our task, participants viewed a set of layouts, each comprising a target and two landmarks. During the test phase participants attempted to place each target in the correct location relative to the two landmarks. Our measure of direction deviation indexed the degree to which the targets were placed on the basis of distance rather than solely on the basis of direction. Our measure of distance deviation indexed the degree to which the targets were placed on the basis of direction rather than solely on the basis of distance. Direction deviation was smaller than distance deviation. The results suggest that direction is more influential than distance in memory for the locations of objects relative to landmarks.

Computing The Energy of Certain Graphs based on Vertex Status

BACKGROUND

The concept of Hückel molecular orbital theory is used to compute the graph energy numerically as well asnd graphically, on the base of the status of a vertex.

OBJECTIVE

Our aim is to explore the graph energy of various graph families on the base of the status adjacency matirx matrix and its Laplacian version.

METHOD

We opt for the technique of finding eigenvalues of adjacency and Laplacian matrices constructed on the base of the status of vertices.

RESULTS

We explore the exact status sum and Laplacian status sum energies of a complete graph, complete bipartite graph, star graphs, bistar graphs, barbell graphs and graphs of two thorny rings. We also compared the obtained results of energy numerically and graphically.

CONCLUSION

In this article, we extended the study of graph spectrum and energy by introducing the new concept of the status sum adjacency matrix and the Laplacian status sum adjacency matrix of a graph. We investigated and visualized these newly defined spectrums and energies of well-known graphs, such as complete graphs, complete bi-graphs, star graphs, friendship graphs, bistar graphs, barbell graphs, and thorny graphs with 3 and 4 cycles.

Visual perspective, distance, and felt presence of others in dreams

The peripersonal space, that is, the limited space surrounding the body, involves multisensory coding and representation of the self in space. Previous studies have shown that peripersonal space representation and the visual perspective on the environment can be dramatically altered when neurotypical individuals self-identify with a distant avatar (i.e., in virtual reality) or during clinical conditions (i.e., out-of-body experience, heautoscopy, depersonalization). Despite its role in many cognitive/social functions, the perception of peripersonal space in dreams, and its relationship with the perception of other characters (interpersonal distance in dreams), remain largely uncharted. The present study aimed to explore the visuospatial properties of this space, which is likely to underlie self-location as well as self/other distinction in dreams. 530 healthy volunteers answered a web-based questionnaire to measure their dominant visuo-spatial perspective in dreams, the frequency of recall for felt distances between their dream self and other dream characters, and the dreamers' viewing angle of other dream characters. Most participants reported dream experiences from a first-person perspective (1PP) (82%) compared to a third-person perspective (3PP) (18%). Independent of their dream perspective, participants reported that they generally perceived other dream characters in their close space, that is, at distance of either between 0 and 90 cm, or 90-180 cm, than in further spaces (180-270 cm). Regardless of the perspective (1PP or 3PP), both groups also reported more frequently seeing other dream characters from eye level (0° angle of viewing) than from above (30° and 60°) or below eye level (-30° and -60°). Moreover, the intensity of sensory experiences in dreams, as measured by the Bodily Self-Consciousness in Dreams Questionnaire, was higher in individuals who habitually see other dream characters closer to their personal dream self (i.e., within 0-90 cm and 90-180 cm). These preliminary findings offer a new, phenomenological account of space representation in dreams with regards to the felt presence of others. They might provide insights not only to our understanding of how dreams are formed, but also to the type of neurocomputations involved in self/other distinction.

An algebraic model for inversion and deletion in bacterial genome rearrangement

Inversions, also sometimes called reversals, are a major contributor to variation among bacterial genomes, with studies suggesting that those involving small numbers of regions are more likely than larger inversions. Deletions may arise in bacterial genomes through the same biological mechanism as inversions, and hence a model that incorporates both is desirable. However, while inversion distances between genomes have been well studied, there has yet to be a model which accounts for the combination of both deletions and inversions. To account for both of these operations, we introduce an algebraic model that utilises partial permutations. This leads to an algorithm for calculating the minimum distance to the most recent common ancestor of two bacterial genomes evolving by inversions (of adjacent regions) and deletions. The algebraic model makes the existing short inversion models more complete and realistic by including deletions, and also introduces new algebraic tools into evolutionary distance problems.

Landscape Genetics for Brazilian Equines

Optimization of DNA collection for National gene bank and conservation programs requires information on spatial and genetic distribution of animals countrywide. The relationship between genetic and geographic distances were examined in 8 Brazilian horse breeds (Baixadeiro, Crioulo, Campeiro, Lavradeiro, Marajoara, Mangalarga Marchador, Pantaneiro and Puruca) using Single Nucleotide Polymorphism markers and collection point locations. Mantel correlations, Genetic Landscape Shape Interpolation, Allelic Aggregation Index Analyses and Spatial autocorrelation tests indicated a nonrandom distribution of horses throughout the country. Minimum collection distances for the national Gene Bank should be 530km, with clear divisions seen in genetic structure of horse populations in both North/South and East/West directions. Comparing Pantaneiro and North/Northeastern breeds, physical distance is not necessarily the defining factor for genetic differentiation. This should be considered when sampling these local breeds. These data can help optimise GenBank collection routines and conservation strategies for these breeds.

On the scope of presupposition in discourse reading comprehension

referential relationships can be communicated through presupposition. The presupposition trigger (also) in Jiayan also bought eggs exerts a pragmatic constraint that besides the object, the verb constrains additional and alternative referents. Our study provided a novel set of evidence that the reader preferred larger- over smaller-sized sets for the scope of presupposition in discourse comprehension. The structural hierarchy in smaller-sized sets and the earlier-mentioned structural details in larger-sized sets drove higher preference. Furthermore, readers' difference in their preference reflected their tendency to attend to discourse structural information. These findings are consistent with the multiple constraints hypothesis/the presupposition maximization principle hypothesis, rather than the local bias hypothesis. The present study enlightened the understanding of structural constraints on processing the number and the identity of presupposed referential information in discourse reading comprehension.

Data on 2341 grass fields from 100 mountain-area dairy farms in France: Agricultural uses and geographical characteristics

This article reports data collected by survey from 100 dairy farmers located in a mountainous area (France), including 72 farmers engaged in the traditional Salers system and 28 farmers engaged in a specialised dairy system. The questionnaire covered all uses of all grass fields during the entire outdoor period, considering 'field' as an area that was used in the same way throughout the entire period. Cutting dates, grazing dates, animal categories and numbers were recorded using a grazing and harvesting schedule. We also recorded key geographical and physical characteristics of each field, i.e. main slope, altitude, area, and distance from the farmstead. Each field in the presented database is thus described by 47 quantitative and qualitative variables.

Event-related potentials in response to early termination and completed decisions in sequential decision-making

The process of outcome evaluation effectively navigates subsequent choices in humans. However, it is largely unclear how people evaluate decision outcome in a sequential scenario, as well as the neural mechanisms underlying this process. To address this research gap, the study employed a sequential decision task in which participants were required to make a series of choices, with the option to terminate their choices. Based on participants' decisions, two outcome patterns were classified: the "reached" condition and the "unreached" condition, and the event-related potentials (ERPs) were recorded. Further, in the unreached condition, we investigated how the distance (i.e., the position interval between the actual outcome and potential outcome) modulated outcome evaluation. Behavioral data showed a higher emotion rating when people got a reward rather than a loss, while the opposite was true in the unreached condition. ERP results showed larger feedback-related negativity (FRN), a smaller P3, and a larger late positive potential (LPP) when people got a loss compared to a reward. Importantly, a hierarchical processing pattern was found in the unreached condition: people processed separately the potential outcome and the distance at the early stage, manifested in the FRN amplitude; subsequently, the brain focused on the distance-a lower distance elicited an enhanced P3 amplitude. Finally, the potential outcome and distance were processed interactively in the LPP amplitude. Overall, these findings shed light on the neural underpinnings of outcome evaluation in sequential decision-making.

Achieving Energy Efficiency and Impact of SAR in a WBAN Through Optimal Placement of the Relay Node

Wireless Body Area Network (WBAN) is an emerging and promising specialized area in Wireless networks that deals with crucial health-related datasets. Unlike other wireless networks, as this type of network deals with medical facts, losing it is fatal. WBAN is a highly constrained network. Reducing energy consumption and enhancing lifetime are the two most important challenges of WBANs. One way to achieve these is by deploying relay nodes optimally in WBANs. Generally, a relay node is placed at the midpoint of the line joining the source and the destination (D) nodes. We show that such simplistic deployment of the relay nodes is not the optimal deployment, which can hamper the overall lifetime of WBANs. In this paper, we have investigated the best location to deploy a relay node on a human body. We assume that an adaptive decode and forward relay node (R) can move linearly between the source (S) and the destination (D) nodes. Moreover, the assumption is that a relay node can be deployed linearly and that the body part of a human is a flat surface and hard. We have investigated the most energy-efficient data payload size based on the optimally placed relay location. The impact of such a deployment on different system parameters, such as distance (d), payload (L), modulation scheme, specific absorption rate, and an end to end outage (O ) are examined as well. It is observed that in every aspect optimal deployment of the relay node performs an important role to enhance the lifetime of wireless body area networks. Sometimes linear relay deployment is very difficult to implement, especially on the different body parts of the human body. To address these issues, we have examined the optimal region for the relay node based on a 3D non-linear system model. The paper provides guidance for both linear and non-linear relay deployment along with the optimal data payload size under various circumstances and also considered the impact of specific absorption rates on the human body.

Objective structured assessment ultrasound skill scale for hyomental distance competence - psychometric study

BACKGROUND

Ultrasound assessment of the airway recently integrates the point-of-care approach to patient evaluation since ultrasound measurements can predict a difficult laryngoscopy and tracheal intubation. Because ultrasonography is performer-dependent, a proper training and assessment tool is needed to increase diagnostic accuracy. An objective, structured assessment ultrasound skill (OSAUS) scale was recently developed to guide training and assess competence. This work aims to study the psychometric properties of OSAUS Scale when used to evaluate competence in ultrasound hyomental distance (HMD) measurement.

METHODS

Prospective and experimental study. Volunteers were recruited and enrolled in groups with different expertise. Each participant performed three ultrasonographic HMD evaluation. The performance was videorecorded and anonymized. Five assessors blindly rated participants' performance using OSAUS scale and a Global Rating Scale (GRS). A psychometric study of OSAUS scale as assessment tool for ultrasound HMD competence was done.

RESULTS

Fifteen voluntaries participated on the study. Psychometric analysis of OSAUS showed strong internal consistency (Cronbach's alpha 0.916) and inter-rater reliability (ICC 0.720; p < 0.001). The novice group scored 15.4±0.18 (mean±SD), the intermediate 14.3±0.75 and expert 13.6±0.1.25, with a significant difference between novice and expert groups (p = 0.036). The time in seconds to complete the task was evaluated: novice (90±34) (mean±SD), intermediate (84±23) and experts (83±15), with no significant differences between groups. A strong correlation was observed between OSAUS and global rating scale (r = 0.970, p < 0.001).

CONCLUSION

The study demonstrated evidence of validity and reliability. Further studies are needed to implement OSAUS scale in the clinical setting for training and assessment of airway ultrasound competence.

Starters and non-starters soccer players in competition: is physical performance increased by the substitutions?

BACKGROUND

Non-starters soccer players have a great role within the team, being indispensable to reduce fatigue, as well as to maintain and increase the team's performance during the match.

OBJECTIVE

This study aimed to analyze the physical performance of the starter and non-starters players during competitive soccer matches.

METHODS

Twenty-two soccer players participated in this study, divided into two groups according to the role in the match (starters or non-starters). WIMU Global Positioning System devices were used in order to record physical performance metrics. Independent samples t-test and one-way ANOVA tests were performed to compare starters and non-starters, and the playing position, respectively, and two-way ANOVA test was perform with these factors too.

RESULTS

There were no differences in the main physical performance metrics between starters and non-starters players during competition, although there were differences in physical performance metrics according to the playing position. Midfielders performed highest distance per minute, player load, and distance covered between 12 and 21 km·h^- 1 (p < .05). Finally, distance covered at speeds greater than 24 km·h^- 1 was predicted by the playing role (starters and non-starters) and playing position factors with 88% of explained variance (η_p² = 0.772).

CONCLUSION

The main findings of this study showed that non-starter players had a similar physical performance during competitive matches as the starter players for whom they are substituted. In addition, the playing position determined different physical performance, contributing in this manuscript that behavior and decision-making of the players could be affected by their position in the field. More studies are needed on non-starter player performance and contextual factors that could influence the physical responses of these players.

Travel distance and time to dermatology clinical trial sites: a cross-sectional geospatial analysis

Despite increasing calls for diversity in clinical trial recruitment, data are lacking regarding disparities in access to dermatologic clinical trials. The objective of this study was to characterize travel distance and time to reach a dermatology clinical trial site considering patient demographic and location characteristics. We determined travel distance and time from every census tract population center in the United States to the nearest dermatologic clinical trial site using ArcGIS and linked travel estimates to demographic characteristics in each census tract based on 2020 American Community Survey. Nationally, patients travel an average of 14.3 miles and 19.7 min to reach a dermatologic clinical trial site. Significantly shorter travel distance and time were observed for urban and Northeast residence, White and Asian race and private insurance relative to rural and Southern residence, Native American and Black race and public insurance (p < 0.001). These findings reveal disparate access regarding geographic region, rurality, race and insurance type, which may encourage investigators to allocate funding for travel assistance for underrepresented and disadvantaged groups to promote access and diversity in dermatologic clinical trials.

Peripheral target detection can be modulated by target distance but not attended distance in 3D space simulated by monocular depth cues

Most studies of visuo-spatial attention present stimuli on a 2D plane, and less is known about how attention varies in 3D space. Previous studies found better peripheral detection performance for targets at a near compared to a far depth, simulated by pictorial cues and optical flow. The current study examined whether target detectability is monotonically related to distance along the depth axis, and whether the attended distance modulates the effect of target distance. We investigated these questions in two experiments that measured how apparent distance and target eccentricity affects peripheral target detection when performed alone during passive simulated self-motion, or during a simultaneous, active central car-following task. Experiment 1 found that targets at an apparent distance of 18.5 virtual meters were detected faster and more accurately than targets at 9.25 and 37 virtual meters, and detectability declined with eccentricity. Experiment 2 examined the effect of the attended location by varying the distance between the viewer and the lead car on which participants were instructed to fixate (i.e. the headway) while equating target distances across headway conditions. Experiment 2 replicated the effects found in Experiment 1, and headway did not modulate the effect of target distance. These results are consistent with the hypothesis that target detection depends non-monotonically on the distance between the viewer and the target, and is not affected by the distance between the target and attended location. However, target detection may also have been affected by stimulus characteristics that co-varied with apparent depth, rather than depth per se.

The effect of geographic origin and destination on congenital heart disease outcomes: a retrospective cohort study

BACKGROUND

Congenital heart disease (CHD) is a common and significant birth defect, frequently requiring surgical intervention. For beneficiaries of the Department of Defense, a new diagnosis of CHD may occur while living at rural duty stations. Choice of tertiary care center becomes a function of geography, referring provider recommendations, and patient preference.

METHODS

Using billing data from the Military Health System over a 5-year period, outcomes for beneficiaries age < 10 years undergoing CHD surgery were compared by patient origin (rural versus urban residence) and the distance to treatment (patient's home and the treating tertiary care center). These beneficiaries include children of active duty, activated reserves, and federally activated National Guard service members. Analysis of the outcomes were adjusted for procedure complexity risk. Treatment centers were further stratified by annual case volume and whether they publicly reported results in the society of thoracic surgery (STS) outcomes database.

RESULTS

While increasing distance was associated with the cost of admission, there was no associated risk of inpatient mortality, one year mortality, or increased length of stay. Likewise, rural origination was not significantly associated with target outcomes. Patients traveled farther for STS-reporting centers (STS-pr), particularly high-volume centers. Such high-volume centers (> 50 high complexity cases annually) demonstrated decreased one year mortality, but increased cost and length of stay.

CONCLUSIONS

Together, these findings contribute to the national conversation of rural community medicine versus regionalized subspecialty care; separation of patients between rural areas and more urban locations for initial CHD surgical care does not increase their mortality risk. In fact, traveling to high volume centers may have an associated mortality benefit.

On triangle inequalities of correlation-based distances for gene expression profiles

BACKGROUND

Distance functions are fundamental for evaluating the differences between gene expression profiles. Such a function would output a low value if the profiles are strongly correlated-either negatively or positively-and vice versa. One popular distance function is the absolute correlation distance, [Formula: see text], where [Formula: see text] is similarity measure, such as Pearson or Spearman correlation. However, the absolute correlation distance fails to fulfill the triangle inequality, which would have guaranteed better performance at vector quantization, allowed fast data localization, as well as accelerated data clustering.

RESULTS

In this work, we propose [Formula: see text] as an alternative. We prove that [Formula: see text] satisfies the triangle inequality when [Formula: see text] represents Pearson correlation, Spearman correlation, or Cosine similarity. We show [Formula: see text] to be better than [Formula: see text], another variant of [Formula: see text] that satisfies the triangle inequality, both analytically as well as experimentally. We empirically compared [Formula: see text] with [Formula: see text] in gene clustering and sample clustering experiment by real-world biological data. The two distances performed similarly in both gene clustering and sample clustering in hierarchical clustering and PAM (partitioning around medoids) clustering. However, [Formula: see text] demonstrated more robust clustering. According to the bootstrap experiment, [Formula: see text] generated more robust sample pair partition more frequently (P-value [Formula: see text]). The statistics on the time a class "dissolved" also support the advantage of [Formula: see text] in robustness.

CONCLUSION

[Formula: see text], as a variant of absolute correlation distance, satisfies the triangle inequality and is capable for more robust clustering.

The effect of distance to health facility on neonatal mortality in Ethiopia

INTRODUCTION

In Ethiopia, more than half of newborn babies do not have access to Emergency Obstetric and Neonatal Care (EmONC) services. Understanding the effect of distance to health facilities on service use and neonatal survival is crucial to recommend policymakers and improving resource distribution. We aimed to investigate the effect of distance to health services on maternal service use and neonatal mortality.

METHODS

We implemented a data integration method based on geographic coordinates. We calculated straight-line (Euclidean) distances from the Ethiopian 2016 demographic and health survey (EDHS) clusters to the closest health facility. We computed the distance in ESRI ArcGIS Version 10.3 using the geographic coordinates of DHS clusters and health facilities. Generalised Structural Equation Modelling (GSEM) was used to estimate the effect of distance on neonatal mortality.

RESULTS

Poor geographic accessibility to health facilities affects maternal service usage and increases the risk of newborn mortality. For every ten kilometres (km) increase in distance to a health facility, the odds of neonatal mortality increased by 1.33% (95% CI: 1.06% to 1.67%). Distance also negatively affected antenatal care, facility delivery and postnatal counselling service use.

CONCLUSIONS

A lack of geographical access to health facilities decreases the likelihood of newborns surviving their first month of life and affects health services use during pregnancy and immediately after birth. The study also showed that antenatal care use was positively associated with facility delivery service use and that both positively influenced postnatal care use, demonstrating the interconnectedness of the components of continuum of care for maternal and neonatal care services. Policymakers can leverage the findings from this study to improve accessibility barriers to health services.

Direction and distance information in memory for locations of objects relative to landmarks and boundaries

An observer often remembers an object's location on the basis of its direction and distance from reference objects. Two kinds of reference object are of particular interest: landmarks and boundaries. We compared how well observers remembered the direction and distance of target objects from a landmark and a boundary. Patterns of variable error implied that the landmark was more effective than the boundary in supporting memory for target object direction. When the predictions of the landmark and the boundary were placed in conflict, patterns of constant error implied that the boundary was more effective than the landmark in supporting memory for target object distance. These results suggest affinities between direction information and landmarks and between distance information and boundaries. They raise the possibility that, rather than collapsing across direction and distance error, theoretical analyses should distinguish the two kinds of error in assessing the reliability of landmarks and boundaries.

Screening for cervical cancer among women in five countries in sub-saharan Africa: analysis of the role played by distance to health facility and socio-demographic factors

BACKGROUND

Cervical cancer significantly affects women in Sub-Saharan Africa (SSA). However, limited studies have concentrated on cervical screening behaviour among women in SSA. This study aimed to assess the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour among women in five SSA countries.

METHODS

The study was based on pooled data of 40,555 women included in Demographic and Health Surveys (DHS) conducted between 2013 to 2021. Proportions and logistic regression models were used in assessing the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour.

RESULTS

Approximately, 7.9% of women that saw the distance to a health facility as a big problem, tested for cervical cancer compared to 13.5% who indicated that distance to a health facility is not a big problem. More women in urban areas, with a higher level of education, of richest wealth index, aged 40-44 years and using contraceptives who also indicated that distance to a health facility was a big problem tested for cervical cancer compared to those in rural areas with no education, of poorest wealth index, aged 15-19 years and not using contraceptives. Education, age, contraceptive use, frequent exposure to mass media and Sexual Transmitted Infections (STI) had a significant relationship with testing for cervical cancer.

CONCLUSION

The prevalence of cervical cancer screening was low in the five SSA countries largely due to distance barriers and was also significantly influenced by education, age, contraceptive use, frequent exposure to mass media, and STI status. To improve the screening for cervical cancer and its associated benefits in the five SSA countries, there is a need for policymakers, clinicians and public health workers to channel more commitment and efforts to addressing the barriers identified in this study.

Nursing students' opinion on the use of Escape ZOOM® as a learning strategy: Observational study

The teaching-learning process has gone through major changes due to the COVID-19 pandemics and it has been left to professors to adapt the teaching process and find ways to keep students engaged. There has been a need to establish collaborative and active strategies for working in the online environment. The development of a game for both teaching and evaluating de interdisciplinary learning content on an online platform may create a gameful experience and stimulating environment that makes complex learning goals achievable. To analyze how nursing students feel in relation to their participation and learning in an Escape Room activity taking place in an online environment. This is a descriptive and exploratory cross-sectional cohort study. The study was carried out in a higher education institution. The sample consisted of 73 students. After implementation of Escape Zoom® in the first semester of 2021, adapted questionnaires to assess students' satisfaction and perception of learning were applied. In the Educational Practices Questionnaire, all statements obtained greater than 70% agreement, which revealed students' satisfaction, especially with learning with colleagues. As for learning, 93.2% of students' statements expressed that the Escape Zoom® favors teamwork and 91.8% of student's statements agreed that the activity is effective for learning and would recommend it to other colleagues. The Escape Zoom® is an effective teaching strategy, perceived with satisfaction by students as a form of learning with colleagues, in a game-oriented way. It also has the potential to promote the development of soft skills.