The effect of competitive and cooperative contexts on comparative optimism

Several common characteristics are shared by competition and comparative optimism; and comparative optimism has often been observed in competitive environments like entrepreneurial fields or areas that require skills. Competitive context could be an explanatory factor for comparative optimism neglected to date. The aim of this article is to test the links between competition (vs. cooperation) and comparative optimism. In Study 1, participants in different academic majors with a more or less competitive nature (respectively, medical studies and human sciences studies) answered questions about their future and that of others. In Study 2, for the participants in the less competitive course of study (human sciences studies), we presented their studies as being either competitive or cooperative. The impact of this context was tested as a function of the closeness or distance between the participants and the comparison targets. The results of both studies showed that competition increased the expression of comparative optimism. In Study 2, this effect emerged more when the comparison target was distant than when it was close, with proximity hindering the competitive relationship between the self and others. The feeling of competition with others contributed to a better understanding of comparative optimism and initiated new explanations for its emergence.

Treatment Patterns and Distance to Treatment Facility for Soft Tissue Sarcoma of the Extremity

BACKGROUND

The impact that distance traveled to receive treatment has on treatments and outcomes among patients with soft tissue sarcoma (STS) of the extremity has yet to be thoroughly investigated.

METHODS

Information on patients treated for STS of the extremity between 2006 and 2015 was obtained from the National Cancer Database. Patients were stratified into two groups based on median distance traveled to receive treatment. Chi-square tests assessed associations between categorical variables and distance to treatment. Kaplan-Meier survival estimates and Cox regression were used to estimate survival.

RESULTS

The sample included 21,763 patients. The mean age was 59.3 y, 54.6% were men, and 83.2% were white. The median distance traveled to the treating facility was 15.6 miles. Compared with patients who traveled <15 miles, those who traveled ≥15 miles were more likely to have undifferentiated rather than well-differentiated tumors (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.10-1.37), and stage II rather than stage I disease (OR, 1.14; 95% CI, 1.04-1.24). They were also more likely to undergo limb-sparing resection (OR, 1.58; 95% CI, 1.39-1.79) or amputation (OR, 1.72; 95% CI, 1.44-2.07) rather than no surgery and less likely to have positive margins (OR, 0.86; 95% CI, 0.79-0.93). There was no difference in the risk of death between patients who traveled ≥15 miles and those who did not (hazard ratio, 1.00; 95% CI, 0.94-1.07).

CONCLUSIONS

Although clinical characteristics and treatments may differ based on distance traveled, survival appears equivalent. Further research into reasons why greater distance traveled is associated with more advanced disease, but comparable survival is warranted.

Phenotypic characterization of Raya cattle in northern Ethiopia

Thirteen qualitative and six morphometric variables on a total of 651 adult cattle (76 oxen and 575 cows) from four purposively selected districts were recorded to characterize the cattle populations in and around the breeding tract of Raya cattle. General linear model, frequency, and multivariate analysis procedures of Statistical Analysis Software (SAS 9.0) were used to analyze the data by splitting and merging the sexes. Higher measurement values for oxen were recorded over the cows. Location affects the studied traits significantly. The cattle population from Habru district was significantly differentiated from Raya cattle. Among the districts of Raya cattle, lowest values for most of the linear measurements were observed in Kobo district. Majority of the Raya cattle possess upright, lyre-shaped horn, small, and erected hump placed at the cervical thoracic position, large dewlap, naval flap, and perpetual sheath sizes and dominantly dark red body color with uniform body color pattern. Stepwise discriminant function analysis reveals horn length, ear length, and height at wither were the first three most important morphometric variables used in discriminating the cattle populations. Canonical discrimination analysis showed that the first canonical structure explains majority (94.13%) of the total variation with eigenvalue of 2.07 and canonical correlation of 82.14%. Discriminant function analysis showed the classification of an average 61% of the studied animals into their respective districts. Pairwise Mahalanobis distances between populations from different districts were found to be highly significant. Habru cattle population relates distantly from Raya cattle except its short distance with Kobo district. The shortest distance was observed between Raya cattle of Alamata and Raya Azebo districts. In conclusion, cattle from Alamata, Raya Azebo, and Kobo districts can be categorized as Raya cattle, while strong similarities between the first two districts in showing the real characteristics and morphology of Raya cattle were also revealed.

Stereoscopic depth constancy from a different direction

To calibrate stereoscopic depth from disparity our visual system must compensate for an object's egocentric location. Ideally, the perceived three-dimensional shape and size of objects in visual space should be invariant with their location such that rigid objects have a consistent identity and shape. These percepts should be accurate enough to support both perceptual judgments and visually-guided interaction. This theoretical note reviews the relationship of stereoscopic depth constancy to the geometry of stereoscopic space and seemingly esoteric concepts like the horopter. We argue that to encompass the full scope of stereoscopic depth constancy, researchers need to consider not just distance but also direction, that is 3D egocentric location in space. Judgements of surface orientation need to take into account the shape of the horopter and the computation of metric depth (when tasks depend on it) must compensate for direction as well as distance to calibrate disparities. We show that the concept of the horopter underlies these considerations and that the relationship between depth constancy and the horopter should be more explicit in the literature.

Perception of family doctors about the online courses offered by the Division of Educational Innovation

BACKGROUND

The Division of Educational Innovation offers open courses training, updating and training courses that promote self-taught learning. It is important to take the user´s perspective into account in the evaluation to improve educational quality.

OBJECTIVE

Analyze the perception of family doctors about the online courses of the platform of The Division of Educational Innovation.

METHOD

Qualitative study, descriptive. Included family doctors who took at least one online course. Their opinion on online courses was asked and the questionnaire MOOC (Massive Online Open Courses) was applied. An analysis of the content of the open questions was carried out, the questionnaire was evaluated globally and by sections.

RESULTS

19 doctors included, 58% women, the majority have taken the online course for updating and professional and personal interest, the main limitation is the lack of time. Registration restrictions, platform failure, course duration time and disinterest are also mentioned. The quality of the courses was measured as regular by 36.8% and low quality by 26.3%, with adaptation to the user and didactic planning being the lowest scores.

CONCLUSIONS

The perception of online courses is good, considering the to be of regular quality, with time being the main limiting factor.

"Not from home": Cancer screening avoidance and the safety of distance in Eswatini

This paper shows how travel and distance make cervical cancer screening safer for women in Eswatini. It is based on three months of original ethnographic research conducted in a semi-urban town in Eswatini from September to December 2014, involving daily participant observation and semi-structured, in-depth interviews with 20 women and 7 health workers. Results of the research show how women use travel to create safer clinical spaces and encounters in the context of cancer screening. Specifically, the research found that in the cervical cancer screening clinic, women's bodies are negatively judged and talked about. This creates fear - of judgment, verbal violence and gossip - all of which are intensified in hospitals and with nurses who are close to home. It is a fearful, laborious and difficult clinical encounter which causes a medical migration, where women seek screening in distant hospitals and with nurses who are "not from home." Distance provides anonymity and minimizes pathways of gossip, thus mitigating fear and making cervical cancer screening safer for women. The social rationale around distance shows how travel can create or recreate clinical spaces and experiences of care in the context of local medical migration. It also upsets culturalist assumptions about women's avoidance of cervical screening. Improving cancer screening programs in Eswatini calls for an approach sensitive to the clinical and social realities that create fear and constrain women's choices.

The effect of distance from cancer facility on advanced clinical stage at diagnosis in patients with cervical cancer

PURPOSE/OBJECTIVES

In the United States, cervical cancer remains a significant cause of morbidity and mortality. The effect of distance has a complicated relationship with disease characteristics and outcomes in other cancers. The purpose of this study is to investigate the relationship between distance from cancer facility on clinical stage at diagnosis in women with cervical cancer.

MATERIALS/METHODS

Data were obtained from the National Cancer Database which include patient demographics, disease characteristics, and treatment details. Persons diagnosed with cervical cancer from 2004 to 2015 were included. Subjects were excluded if they had missing information, variant histology, or lived >1,000 miles from their facility resulting in 51,413 persons. Disease was classified as localized (stage 1a-2a) or advanced (stage 2b-4b). Univariate comparisons were performed using analysis of variance and chi-square test. Multivariable logistic regression was used to investigate the effect of distance quartiles on advanced stage while adjusting for other significant variables.

RESULTS

Mean age was 51.0 years, 16.9% of women were black, 14.7% were Hispanic, 45.0% had private insurance, and 10.7% were uninsured. Overall, 50.9% of women presented with advanced disease. In multivariable analysis, greater distance demonstrated a stepwise risk reduction of advanced disease where those in the farthest quartile had odds ratio of 0.73 (p<0.001) relative to the closest. Additionally, age, race, income, and insurance status significantly affected risk of advanced disease.

CONCLUSIONS

Distance from cancer facility resulted in lower risk of advanced stage disease at diagnosis. Additional research could elucidate the nuanced relationship between distance, disease characteristics and outcomes in cervical cancer.

The sim must go on: adapting resident education to the COVID-19 pandemic using telesimulation

The COVID-19 pandemic and social distancing rules necessitated the suspension of all in-person learning activities at our institution. Consequently, distance learning became essential. We adapted a high-fidelity immersive case-based simulation scenario for telesimulation by using the virtual meeting platform Zoom® to meet our curricular needs. The use of telesimulation to teach a complex case-based scenario is novel. Two cohorts of anesthesiology residents participated 2 weeks apart. All learners were located at home. Four faculty members conducted the telesimulation from different locations within our simulation center in the roles of director, simulation operator, confederate anesthesiologist, and confederate surgeon. The anesthesiologist performed tasks as directed by learners. The scenario was divided into four scenes to permit reflection on interventions/actions by the participants based on the clinical events as the scenario progressed, to facilitate intermittent debriefing and learner engagement. All residents were given a medical knowledge pretest before the telesimulation and a posttest and learner satisfaction survey at the conclusion. The scenario was authentic and immersive, represented an actual case, and provided the opportunity to practice lessons that could be applied in the clinical setting. Participants rated telesimulation a reasonable substitution for in-person learning and expressed gratitude for continuation of their simulation-based education in this format during the pandemic. Participants in the second cohort reported feeling more engaged (p = 0.008) and stimulated to think critically (p = 0.003). Audio quality was the most frequently noted limitation. Fifty-three residents completed both pre- and posttests. The two cohorts did not differ in knowledge pretest scores (62% vs 60%, p = 0.80) or posttest scores (78% vs. 77%, p = 0.87). Overall, knowledge scores improved with the telesimulation intervention (pretest mean = 61% [SD = 14%]; posttest mean = 78% [SD = 12%]; t (41) = - 7.89, p < 0.001). Thus, using a Zoom format, we demonstrated the feasibility of adapting a complex case for telesimulation and effective knowledge gain. Furthermore, we improved our process in real time based on participant feedback. Participants were satisfied with their learning experience, suggesting that this format may be used in other distance learning situations.

The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-1998

Background

Despite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates.

Methods

We combined retrospective reports on 18,714 births between 1980 and 1998 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. We estimated associations between distance to nearest health facility and (i) under-5 mortality, using Cox proportional hazards models, and (ii) maternal health care utilization (antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery), using linear probability models. We also estimated the causal effect of reducing the distance to nearest facility on those outcomes, using a two-way fixed effects approach.

Findings

We found that greater distance was associated with higher mortality (hazard ratio 1.007 for one additional kilometer [95%CI 1.001 to 1.014]) and lower health care utilization (for one additional kilometer: 1.2 percentage point (pp) increase in homebirth [95%CI 0.8 to 1.5]; 0.8 pp. decrease in at least three antenatal visits [95% CI − 1.4 to − 0.2]; 1.2 pp. decrease in skilled assistance during delivery [95%CI − 1.6 to − 0.8]). However, we found no effects of a decrease in distance to the nearest health facility on the hazard of death before age 5 years, nor on antenatal visits prior to delivery, place of delivery, or receiving skilled assistance during delivery. We also found that reductions in distance decrease the probability that a woman receives a check-up following delivery (2.4 pp. decrease for a 1 km decrease [95%CI 0.004 to 0.044]).

Conclusion

Reducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure. Importantly, the effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors.

Online Distance Learning in Biomedical Sciences: Community, Belonging and Presence

In higher education (HE), distance learning (DL) has increased worldwide. Many educational establishments have embraced online distance learning (ODL), with online courses being delivered by a great number of institutions, ranging from community colleges to major universities world-wide. Distance learning (DL) is not a new concept (Keegan D. Theoretical principles of distance education, London, Routledge, 1993), it dates as far back as the eighteenth century as a means of providing access to those who would otherwise not be able to participate in face-to-face educational courses. Traditional DL courses lacked interactivity and the emergence of computers and the internet provided the opportunity for learners to undertake online distance learning (ODL). Many ODL students are biomedical professionals juggling work and family commitments, and therefore the ability to study at a time and place that suits them allows them to engage in learning that they otherwise would not be able to do without relocating. However, whilst ODL offers greater learning opportunities, the lack of campus time and face-to-face learning contact can result in learners feeling isolated.Knowledge is constructed in the midst of interactions with others and is shaped by the skills and abilities valued in a particular culture. Thus, the teacher plays a key role in this learning process in shaping the leaning activities and supporting the development of knowledge and understanding. Therefore, it can be said that the role of the ODL instructor differs from that associated with traditional on-campus education. The instructor becomes the facilitator to support student learning, whilst the student actively participates in what and how knowledge is imparted. Consequently, students studying online are often required to take on a greater responsibility for their own learning. They learn more independently than the on-campus students, as they cannot just simply follow what the other students are doing, they must log into the VLE as a solitary initiative and interact with fellow students and their tutor of their own accords, this chapter looks at how presence and belonging can be supported in ODL as well as supporting staff and students to transition to ODL.

Inferring Metric Trees from Weighted Quartets via an Intertaxon Distance

A metric phylogenetic tree relating a collection of taxa induces weighted rooted triples and weighted quartets for all subsets of three and four taxa, respectively. New intertaxon distances are defined that can be calculated from these weights, and shown to exactly fit the same tree topology, but with edge weights rescaled by certain factors dependent on the associated split size. These distances are analogs for metric trees of similar ones recently introduced for topological trees that are based on induced unweighted rooted triples and quartets. The distances introduced here lead to new statistically consistent methods of inferring a metric species tree from a collection of topological gene trees generated under the multispecies coalescent model of incomplete lineage sorting. Simulations provide insight into their potential.

Comprehensive analysis and recommendation of feature evaluation measures for intrusion detection

The revolutionary advances in network technologies have spearheaded the design of advanced cyberattacks to surpass traditional security defense with dreadful consequences. Recently, Intrusion Detection System (IDS) is considered as a pivotal element in network security infrastructures to achieve solid line of protection against cyberattacks. The prime challenges presented to IDS are curse of high dimensionality and class imbalance that tends to increase the detection time and degrade the efficiency of IDS. As a result, feature selection plays an important role in enabling to identify the most significant features for intrusion detection. Although, several feature evaluation measures are being proposed for feature selection in literature, there is no consensus on which measures are best for intrusion detection. Therein, this work aims at recommending the most appropriate feature evaluation measure for building an efficient IDS. In this direction, four filter-based feature evaluation measures that stem from different theories such as Consistency, Correlation, Information and Distance are investigated for their potential implications in enhancing the detection ability of IDS model for different classes of attacks. Along with this, the influence of the selected features on classification accuracy of an IDS model is analyzed using four different categories of classifiers namely, K-nearest neighbors (KNN), Random Forest (RF), Support Vector Machine (SVM) and Deep Belief Network (DBN). Finally, a two-step statistical significance test is conducted on the experimental results to determine which feature evaluation measure contributes statistically significant difference in IDS performance. All the experimental comparisons are performed on two benchmark intrusion detection datasets, NSL-KDD and UNSW-NB15. In these experiments, consistency measure has best influenced the IDS model in improving the detection ability with regard to detection rate (DR), false alarm rate (FAR), kappa statistics (KS) and identifying the most significant features for intrusion detection. Also, from the analysis results, it is revealed that RF is the ideal classifier to be used in conjunction with any of these four feature evaluation measures to achieve better detection accuracy than others. From the statistical results, we recommend the use of consistency measure for designing an efficient IDS in terms of DR and FAR.

Virtual follow-up and care for patients with cardiac electronic implantable devices: protocol for a systematic review

BACKGROUND

Capacity to deliver outpatient care for patients with cardiac implantable electronic devices (CIEDs) may soon be outweighed by need. This systematic review aims to investigate the comparative effectiveness, safety, and cost for virtual or remote clinic interventions for patients with CIEDs and explores how outcomes may be influenced by patient or system factors in-depth.

METHODS

We will perform a systematic literature search in MEDLINE, Embase, PsycINFO, CINAHL, Proquest Dissertations & Theses, other EBM Reviews, and trial registry databases. Two authors will independently screen titles and abstracts for eligibility. We will include randomized and non-randomized controlled trials, quasi-randomized and experimental studies, cohort, and case-control studies. Study populations of interest are individuals with a CIED (pacemaker, ICD, CRT). Eligibility will be restricted to virtual or remote follow-up or care interventions compared to any other approach. The co-primary outcomes of interest are mortality and patient satisfaction. Secondary outcomes include clinical effectiveness (e.g., ICD shock, time-to-detection of medical event, hospitalizations), safety (e.g., serious or device-related adverse events), device efficacy (e.g., transmissions, malfunctions), costs, workflow (e.g., resources, process outcomes, time-saved), and patient reported (e.g., burden, quality of life). Data will be extracted by one author and checked by a second using a standardized template. We will use published frameworks to capture data relevant to intervention effects that may be influenced by intervention definition or complexity, context and setting, or in socially disadvantaged populations. Detailed descriptive results will be presented for all included studies and outcomes, and where feasible, synthesized using meta-analysis. Risk of bias will be assessed by two review authors independently using Cochrane Risk of Bias tools. Certainty of evidence will be assessed using the GRADE approach.

DISCUSSION

Increases in number of CIEDs implanted, combined with an aging population and finite health resource allocations at the system-level may lead to increased reliance on virtual follow-up or care models in the future. These models must prioritize consistent, equitable, and timely care as a priority. Results from this systematic review will provide important insight into the potential contextual factors which moderate or mediate the effectiveness, safety, and cost of virtual follow-up or care models for patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42020145210.

A visual Hg2+ detection strategy based on distance as readout by G-quadruplex DNAzyme on microfluidic paper

In this work, we have developed a simple, fast and visual Hg²⁺ detection strategy based on distance as readout on paper chip by the Hg²⁺-mediated formation of G-quadruplex-hemin DNAzymes. In the presence of Hg²⁺, the two oligonucleotides hybridize to form G-quadruplex DNA by T-Hg²⁺-T base pair, which was able to bind hemin to form the catalytically active G-quadruplex-hemin DNAzymes. Once DNAzymes were added to react with the precipitated 3,3,5,5-tetramethyl benzidine (TMB) immobilized on the sample area, a visible color band was produced, and the formed length was positively correlated with the concentration of Hg²⁺. This biosensor is capable of selectively detecting mercuric ions with good reproducibility and satisfactory dynamic range. The limit of detection was low to 0.23 nM. Therefore, this strategy not only provides a visual and quick screen of Hg²⁺, but also shows a promising future in monitoring analysis of other metal ions in POC diagnostic field.

Distance learning in the era of COVID-19

The novel coronavirus (SARS-CoV-2) pandemic has necessitated a dramatic shift in how our dermatology residents and fellows are educated. Distance or online learning has become the norm, and several national and international academic societies have combined resources to assure that continuing medical education occurs during this difficult time. The purpose of this communication is to review select online resources available to dermatology trainees and to encourage our colleagues to continue to advance our specialty through distance learning.

Rural Ghanaian households are more likely to use alternative unimproved water sources when water from boreholes has undesirable organoleptic characteristics

Sustainable Development Goal (SDG) 6 aims to achieve universal access to safe drinking water sources. However, the health benefits of meeting this goal will only be fully realized if improved sources are used to the exclusion of unimproved sources. Very little is known about how rural African households balance the use of improved and unimproved water sources when multiple options are present. We assessed parallel use of untreated surface water and unimproved hand-dug wells (HDWs) in the presence of boreholes (BHs) using a semi-quantitative water use survey among 750 residents of 15 rural Ghanaian communities, distributed across three BH water quality clusters: control, high salinity, and high iron. Multivariate mixed effects logistic regression models were used to assess the impact of water quality cluster on the use of BHs, HDWs, and surface water, controlling for distance to the nearest source of each type. Reported surface water use was significantly higher in the high salinity and high iron clusters than in the control cluster, especially for water-intensive activities. Respondents in the non-control clusters had approximately eight times higher odds of clothes washing with surface water (p < 0.01) than in the control. Respondents in the high salinity cluster also had 4.3 times higher odds of drinking surface water (p < 0.05). BH use was high in all clusters, but decreased substantially when distance to the nearest BH exceeded 300 m (OR = 0.17-0.25, p < 0.001). Water use from all sources was inversely correlated with distance, with the largest effect observed on HDW use in multivariate models (OR = 0.02, p < 0.001). Surface water and HDW use will likely continue despite the presence of BHs when perceived groundwater quality is poor and other water sources are in close proximity. It is essential to account for naturally-occurring but undesirable groundwater quality parameters in rural water planning to ensure that SDG 6 is met and health benefits are realized.

Weighted Mostar indices as measures of molecular peripheral shapes with applications to graphene, graphyne and graphdiyne nanoribbons

In this study we consider relatively new bond-additive Mostar indices that appear to provide quantitative measures of peripheral shapes of molecules. We have computed weighted Mostar, edge-Mostar and total-Mostar indices of graphene, [Formula: see text]-types of graphyne and graphdiyne, which are of considerable interest owing to their novel properties and thus find applications in a number of areas such as sensors, catalysis, chemisorption and nanomedicine. We have implemented the results to analyse the weighted Mostar indices and have obtained exact analytical expressions for the title molecules. We propose that Mostar indices together with frontier molecular orbitals, and HOMO-LUMO gaps can provide measures of chemical reactivity and analysis of peripheral molecular shapes.

Cervical cancer screening behaviors and proximity to federally qualified health centers in South Carolina

INTRODUCTION

Lack of participation in cervical cancer screening in underserved populations has been attributed to access to care, particularly among women in rural areas. Federally Qualified Health Centers (FQHCs) were created to address this need in medically underserved populations. This study observed proximity to three health centers in relation to cervical cancer screening rates in South Carolina.

METHODS

Data were obtained from FQHC patient visits (from 3 centers) between 2007-2010 and were limited to women eligible for cervical cancer screening (n = 24,393). ArcGIS was used to geocode patients addresses and FQHC locations, and distance was calculated. Modified Poisson regression was used to estimate relative risk of obtaining cervical cancer screening within one yearor ever, stratified by residential area.

RESULTS

Findings differed markedly by center and urban/rural status. At two health clinics, rural residents living the furthest away from the clinic (∼9 miles difference between quartile 4 and quartile 1) were more likely to be ever screened (RRs = 1.05 and 1.03, p-values < 0.05), while urban residents living the furthest away were less likely to be ever screened (RR = 0.85, p-value < 0.05). At the third center, only urban residents living the furthest away were more likely to be ever screened (RR = 1.02, p-value < 0.05).

CONCLUSIONS

Increased travel distance significantly increased the likelihood of cervical cancer screening at two FQHC sites while significantly decreasing the likelihood of screening at the 3rd site. These findings underscore the importance of contextual and environmental factors that impact use of cervical cancer screening services.

Characteristics of the gait initiation phase in older adults with diabetic peripheral neuropathy compared to control older adults

BACKGROUND

Gait is deteriorated in older adults with diabetic peripheral neuropathy; however, too little is known about the gait initiation phase. We aimed to determine if gait initiation variables are more sensitive in identifying the extent to which diabetic peripheral neuropathy impacts gait.

METHODS

We examined steps, distance, speed and dynamic balance in the gait initiation phase using a validated algorithm based on wearable sensors in 38 older adults with diabetic peripheral neuropathy and 33 non-diabetic, non-neurologic, non-orthopedic control older adults (≥65 years) under single-task and dual-task gait conditions.

FINDINGS

During the single-task gait condition, the largest differences between the two groups were found in gait initiation steps and dynamic balance (66.7% more steps and 57.2% poorer balance for the diabetic group; effect size = 1.08 and 1.11, respectively; all p < 0.05), while gait speed had a medium effect (10.9% slower for the diabetic group; effect size = 0.54; p < 0.05). Although gait deteriorated for both groups during the dual-task gait condition compared to the single-task gait condition, effect sizes of the between-group differences remained similar. The differences in gait initiation steps and dynamic balance between the two groups were independent of gait speed.

INTERPRETATION

Gait initiation steps and dynamic balance may be more sensitive than gait speed for detecting gait deterioration due to diabetic peripheral neuropathy. Given the association between gait initiation and risk for fall, our findings suggest that gait initiation variables may be important outcomes for clinical management of diabetic peripheral neuropathy.

Factors associated with using alternative sources of primary care: a cross-sectional study

BACKGROUND

Mobile (MHCs), Community (CHCs), and School-based health clinics (SBHCs) are understudied alternative sources of health care delivery used to provide more accessible primary care to disenfranchised populations. However, providing access does not guarantee utilization. This study explored the utilization of these alternative sources of health care and assessed factors associated with residential segregation that may influence their utilization.

METHODS

A cross-sectional study design assessed the associations between travel distance, perceived quality of care, satisfaction-adjusted distance (SAD) and patient utilization of alternative health care clinics. Adults (n = 165), child caregivers (n = 124), and adult caregivers (n = 7) residing in New Orleans, Louisiana between 2014 and 2015 were conveniently sampled. Data were obtained via face-to face interviews using standardized questionnaires and geospatial data geocoded using GIS mapping tools. Multivariate regression models were used to predict alternative care utilization.

RESULTS

Overall 49.4% of respondents reported ever using a MCH, CHC, or SBHC. Travel distance was not significantly associated with using either MCH, CHC, or SBHC (OR = 0.91, 0.74-1.11 p > .05). Controlling for covariates, higher perceived quality of care (OR = 1.02, 1.01-1.04 p < .01) and lower SAD (OR = 0.81, 0.73-0.91 p < .01) were significantly associated with utilization.

CONCLUSIONS

Provision of primary care via alternative health clinics may overcome some barriers to care but have yet to be fully integrated as regular sources of care. Perceived quality and mixed-methods measures are useful indicators of access to care. Future health delivery research is needed to understand the multiple mechanisms by which residential segregation influences health-seeking behavior.

Development of a Research-Based Teaching Course as Blended-Learning Format in a Medical Informatics Program

We consider Medical Informatics programs at universities as one of the main education resources for young scientists in our field and thus present a new design for a course teaching scientific skill at the University of Heidelberg as blended-learning format. We utilize common E-learning methods and created the whole course with respect to the concept of research-based teaching. Finally, we present our lessons learned from the current activities of the course.

A meta-analysis of selected near-road air pollutants based on concentration decay rates

Traffic-related air pollution has been associated with various health risks for human populations living near roadways. Understanding the relationship between traffic density and dispersion of vehicle-released air pollutants is important for assessing human exposure to near-road air pollutants. We performed a literature survey targeting publications containing measurement data of traffic-related air pollutants near roads with distance information on their concentration distribution. Concentration decay rates over down-wind distance away from major roads were calculated for black carbon (BC), carbon monoxide (CO) and nitrogen oxides (NO₂ or NO_x) and meta-data analysis on these rates was performed. These analyses showed metadata-based exponential decay rates of 0.0026, 0.0019, 0.0004, and 0.0027 m⁻¹ for BC, CO, NO₂ and NOx, respectively. Using these measurement data-based decay rates, concentrations for BC, CO, NO₂ and NO_x over various near-road distances were predicted. These results are useful for enhancing exposure modeling and thus more reliably assessing the health risk of exposure to near road air pollution.

PAIN AND PHYSICAL PERFORMANCE AMONG RECREATIONAL RUNNERS WHO RECEIVE A CORRECTION FOR AN ILIAC CREST HEIGHT DIFFERENCE: A CASE SERIES

BACKGROUND

Leg-length inequality (LLI) is a musculoskeletal condition where one lower extremity is longer than the other. There is conflicting evidence on the relevance of LLI and conservative treatment options. Iliac crest height difference (ICHD) is a good estimate of LLI.

OBJECTIVE

To observe changes in pain and performance among recreational runners with running-induced lower extremity pain who received ICHD correction.

METHODS

A 12-week case series with multiple baseline and intervention (A-B-A-B) phases was used to observe the effects of ICHD correction on pain and performance among three symptomatic recreational runners. Primary outcome measures included the Lower Extremity Functional Scale (LEFS), the Visual Analog Scale -Worst Pain (VAS-W), symptom-free running distance, and average running speed. A standardized procedure for fabricating an in-shoe shim was utilized for ICHD correction.

RESULTS

There were no clinically important differences in functional capacity for any subject between any phases. Also, two subjects demonstrated trends towards increased pain over the 12-week experimental period, whereas one subject demonstrated a decrease. One subject demonstrated a statistically significant increase in running distance during intervention phases, but the others demonstrated reductions. All subjects demonstrated trends towards increased running speed, but none were statistically significant.

CONCLUSION

The correction of small ICHD < 9mm did not improve pain or performance among recreational runners. Individuals with small ICHD may be able to effectively compensate for lower extremity asymmetries; therefore, correction seems to be unnecessary and potentially harmful in short-term.

LEVEL OF EVIDENCE

Therapy, level 4.

Predicted changes in abortion access and incidence in a post-Roe world

OBJECTIVE

To examine changes in travel distance and abortion incidence if Roe v. Wade were reversed or if abortion were further restricted.

STUDY DESIGN

We used a national database of abortion facilities to calculate travel distances from the population centroids of United States counties to the nearest publicly-identifiable abortion facility. We then estimated these travel distances under two hypothetical post-Roe scenarios. In the first, abortion becomes illegal in eight states with preemptive "trigger bans." In the second, abortion becomes illegal in an additional 13 states classified as at high risk of outlawing abortions under most circumstances. Using previously-published estimates of the short-run causal effects of increases in travel distances on abortion rates in Texas, we estimate changes in abortion incidence under each scenario.

RESULTS

If Roe were reversed and all high-risk states banned abortion, 39% of the national population of women aged 15-44 would experience increases in travel distances ranging from less than 1 mile to 791 miles. If these women respond similarly to travel distances as Texas women, county-level abortion rates would fall by amounts ranging from less than 1% to more than 40%. Aggregating across all affected regions, the average resident is expected to experience a 249 mile increase in travel distance, and the abortion rate is predicted to fall by 32.8% (95% confidence interval 25.9-39.6%) in the year following a Roe reversal.

CONCLUSION

In the year following a reversal, increases in travel distances are predicted to prevent 93,546-143,561 women from accessing abortion care.

IMPLICATIONS

A reversal or weakening of Roe is likely to increase spatial disparities in abortion access. This could translate to a reduction in abortion rates and an increase in unwanted births and self-managed abortions.

Reasons for delay in seeking treatment among women with obstetric fistula in Tanzania: a qualitative study

BACKGROUND

Obstetric fistula is among the serious and distressing maternal morbidities in Tanzania. Obstetric fistula is a childbirth-related injury caused by prolonged and obstructed labor which has a devastating impact on affected women and their families. The aim of this study was to explore reasons why women with obstetric fistula admitted to the Comprehensive Community- Based Rehabilitation in Tanzania (CCBRT) hospital delayed seeking fistula treatment.

METHODS

This exploratory study incorporated qualitative approach. In-depth interviews were used to collect data from 18 women with obstetric fistula admitted to CCBRT hospital. The interviews were conducted in Kiswahili and lasted for 40-45 min. Audio-recordings of the interviews were transcribed verbatim and translated into English. Thematic analysis was used to extract reasons for the delay in seeking treatment for obstetric fistula.

RESULTS

The study sample (n = 18) ranged in age from 20 to 57 (μ = 37; SD = 11.67), married (n = 14), unemployed (n = 15), and very low level education (n = 15) with primary education. Delay in seeking treatment for obstetric fistula was related to the following themes: inadequate knowledge about the causes and treatment of obstetric fistula, distance and transport cost to a health facility, stigma, community isolation, social isolation and use of traditional and cultural.

CONCLUSION

The Tanzanian Ministry of Health in collaboration with private institutions should strengthen education programmes on the nature and causes of obstetric fistula, and increase the availability of treatment to decrease the effect of this condition for women in Tanzania.