Detection of H2O2 and catalase on a paper-based flow sensor constructed with borate cross-linked PVA hydrogel

The detections of H2O2 and catalase play an important role in daily life. This study introduces a paper-based flow sensor that is specifically designed to detect H2O2 and catalase. The sensor utilizes a hydrogel composed of cross-linked 4-carboxyphenylboronic acid and polyvinyl alcohol. When H2O2 is in contact with the hydrogel, the B-C bonds of the hydrogel undergo a reactive process, causing decomposition of the hydrogel. The pH indicator strip enables the visual monitoring of the viscosity change that occurs during the gel-sol transition. The quantification of H2O2 is accomplished by assessing the proportion of water coverage on the pH indicator strip. The sensor shows a detection limit of 0.077 wt% and is applicable for the quantitative measurement of H2O2 in routinely used disinfectants. Furthermore, the presence of catalase is effectively identified and the detection of catalase in milk is successfully fulfilled. In summary, this work proposes a simple, user-friendly, label-free, and cost-effective method for constructing a paper-based flow sensor using borate cross-linked polyvinyl alcohol hydrogel, showing great potential for detecting H2O2 and catalase in various practical scenarios.

Online vs in-person delivery of preclinical coursework: A retrospective cohort study evaluating National Board of Chiropractic Examiners performance

OBJECTIVE

To evaluate the association between basic science curriculum delivery method with other academic and demographic factors on National Board of Chiropractic Examiners (NBCE) part I pass rates.

METHODS

This was a retrospective cohort study of students from 3 campuses of 1 chiropractic institution who matriculated in 2018 or 2020. COVID-19 regulations required online delivery of a basic science curriculum for students in the 2020 cohorts, whereas students in the 2018 cohorts experienced a traditional classroom delivery. A general linear model estimated odds ratios for passing NBCE part I, comparing individual online cohorts with the combined classroom cohort while adjusting for academic and demographic variables.

RESULTS

A total of 968 students were included, 55% from the classroom cohort. The spring 2020 cohort had the fewest students with bachelors' degrees (59%) and more students with high in-program grade point averages (GPA; 61%) along with the lowest estimated odds ratio [0.80 (95% CI: 0.73-0.87)] for passing vs the classroom cohort. The fall 2020 cohort had significantly higher odds [1.06 (95% CI: 1.00-1.03)] of passing vs the classroom cohort. Additional predictors included main campus matriculation, white ethnicity, bachelors' degree, no alternative admission status, and in-program GPA. Students with high in-program GPA (vs low) had a 36% increased odds of passing.

CONCLUSION

Compared to the classroom cohort, the spring 2020 cohort had the lowest odds while the fall 2020 cohort had the highest odds of passing part I. In-program GPA had the highest association with passing. These results provide information on how curriculum delivery impacts board exam performance.

The contribution of semantic distance knowledge to size constancy in perception and grasping when visual cues are limited

To achieve a stable perception of object size in spite of variations in viewing distance, our visual system needs to combine retinal image information and distance cues. Previous research has shown that, not only retinal cues, but also extraretinal sensory signals can provide reliable information about depth and that different neural networks (perception versus action) can exhibit preferences in the use of these different sources of information during size-distance computations. Semantic knowledge of distance, a purely cognitive signal, can also provide distance information. Do the perception and action systems show differences in their ability to use this information in calculating object size and distance? To address this question, we presented 'glow-in-the-dark' objects of different physical sizes at different real distances in a completely dark room. Participants viewed the objects monocularly through a 1-mm pinhole. They either estimated the size and distance of the objects or attempted to grasp them. Semantic knowledge was manipulated by providing an auditory cue about the actual distance of the object: "20 cm", "30 cm", and "40 cm". We found that semantic knowledge of distance contributed to some extent to size constancy operations during perceptual estimation and grasping, but size constancy was never fully restored. Importantly, the contribution of knowledge about distance to size constancy was equivalent between perception and action. Overall, our study reveals similarities and differences between the perception and action systems in the use of semantic distance knowledge and suggests that this cognitive signal is useful but not a reliable depth cue for size constancy under restricted viewing conditions.

Enhancing underwater target localization through proximity-driven recurrent neural networks

Environmental monitoring, ocean research, and underwater exploration are just a few of the marine applications that require precise underwater target localization. This study goes into the field of underwater target localization using Recurrent Neural Networks (RNNs) enhanced with proximity-based approaches, with a focus on mean estimation error as a performance metric. In complex and dynamic underwater environments, conventional localization systems frequently face challenges such as signal degradation, noise interference, and unstable hydrodynamic conditions. This paper presents a novel approach to employing RNNs to increase the accuracy of underwater target localization by exploiting the temporal dynamics of proximity-informed data. This method uses an RNN architecture to track changes in audio emissions from underwater targets sensed by a microphone network. Using the temporal correlations represented in the data, the RNN learns patterns indicative of target localization quickly and correctly. Furthermore, the addition of proximity-based features increases the model's ability to understand the relative distances between hydrophone nodes and the target, resulting in more accurate localization estimates. To evaluate the suggested methodology, thorough simulations and practical experiments were carried out in a variety of underwater environments. The results show that the RNN-based strategy beats conventional methods and works effectively even in difficult settings. The utility of the proximity-aware RNN model is demonstrated, in particular, by considerable reductions in the mean estimate error (MEE), an important performance measure.

A new distance between rankings

This paper analyzes the behavior of the well-known Spearman's footrule distance (F-distance) to measure the distance between two rankings over the same set of objects. We show that F-distance is not invariant to labeling, and therefore, it suffers from a serious drawback for its use in applications. To circumvent this problem, we propose a new distance between rankings which is invariant under indexing (i.e., labeling) and appears as a good alternative to the direct use of F-distance between rankings, and also the invariant-under-indexing Kemeny's distance as well. We also show how our new distance can work with importance weights. Some simple examples are given to show the interest of our method with respect to the classical one based on F-distance and Kemeny's distance.

Living in high-poverty areas is associated with reduced survival in patients with thoracoabdominal aortic aneurysms

OBJECTIVES

Studies have demonstrated that socioeconomic status, insurance, race, and distance impact clinical outcomes in patients with abdominal aortic aneurysms. The purpose of this study was to assess if these factors also impact clinical outcomes in patients with thoracoabdominal aortic aneurysms (TAAAs).

METHODS

We conducted a retrospective review of patients with TAAAs confirmed by computed tomography imaging between 2009 and 2019 at a single institution. Patients' zip codes were mapped to American Community Survey Data to obtain geographic poverty rates. We used the standard U.S. Census definition of high-poverty concentration as >20% of the population living at 100% of the poverty rate. Our primary outcome was overall survival, stratified by whether the patient underwent repair.

RESULTS

Of 578 patients, 575 had zip code data and were analyzed. In both the nonoperative (N = 268) and operative (N = 307) groups, there were no significant differences in age, race, comorbidities, clinical urgency, surgery utilization, or surgery modality between patients living in high-poverty areas (N = 95, 16.4%) vs not. In the nonoperative group, patients from high-poverty areas were more likely to have aneurysm due to dissection (37.5% vs 17.6%, P = .03). In multivariate analyses, patients from high-poverty zip codes had significantly worse nonoperative survival (hazard ratio [HR]: 1.9, 95% confidence interval [CI]: 1.1-3.3, P = .03). In the repair group, high poverty was also a significant predictor of reduced postoperative survival (HR: 1.65, 95% CI: 1-2.63, P = .04). Adding the Gagne Index, these differences persisted in both groups (nonoperative: HR: 1.93, 95% CI: 1.01-3.70, P = .05; operative: HR: 1.62, 95% CI: 1.03-2.56, P = .04). In Kaplan-Meier analysis, the difference in postoperative survival began approximately 1.5 years after repair. Private insurance was predictive of improved postoperative survival (HR: 0.42, 95% CI: 0.18-0.95, P = .04) but reduced nonoperative survival (HR: 2.05, 95% 1.01-4.14, P = .04). Data were insufficient to determine if race impacted survival discretely from poverty status. These results were found after adjusting for age, race, sex, maximum aortic diameter, coronary artery disease, distance from the hospital, insurance, and active smoking. Interestingly, in multivariate regression, traveling greater than 100 miles was correlated with increased surgery utilization (odds ratio: 1.58, 95% CI: 1.08-2.33, P = .02) and long-term survival (HR: 0.61, 95% CI: 0.41-0.92, P = .02).

CONCLUSIONS

Patients with TAAAs living in high-poverty areas had significantly more dissections and suffered a nearly doubled risk of mortality compared with patients living outside such areas. These data suggest that these disparities are attributed to the overall impacts of poverty and highlight the pressing need for research into TAAA disparities.

Impaired proprioception and magnified scaling of proprioceptive error responses in chronic stroke

BACKGROUND

Previous work has shown that ~ 50-60% of individuals have impaired proprioception after stroke. Typically, these studies have identified proprioceptive impairments using a narrow range of reference movements. While this has been important for identifying the prevalence of proprioceptive impairments, it is unknown whether these error responses are consistent for a broad range of reference movements. The objective of this study was to characterize proprioceptive accuracy as function of movement speed and distance in stroke.

METHODS

Stroke (N = 25) and controls (N = 21) completed a robotic proprioception test that varied movement speed and distance. Participants mirror-matched various reference movement speeds (0.1-0.4 m/s) and distances (7.5-17.5 cm). Spatial and temporal parameters known to quantify proprioception were used to determine group differences in proprioceptive accuracy, and whether patterns of proprioceptive error were consistent across testing conditions within and across groups.

RESULTS

Overall, we found that stroke participants had impaired proprioception compared to controls. Proprioceptive errors related to tested reference movement scaled similarly to controls, but some errors showed amplified scaling (e.g., significantly overshooting or undershooting reference speed). Further, interaction effects were present for speed and distance reference combinations at the extremes of the testing distribution.

CONCLUSIONS

We found that stroke participants have impaired proprioception and that some proprioceptive errors were dependent on characteristics of the movement (e.g., speed) and that reference movements at the extremes of the testing distribution resulted in significantly larger proprioceptive errors for the stroke group. Understanding how sensory information is utilized across a broad spectrum of movements after stroke may aid design of rehabilitation programs.

Excavating important nodes in complex networks based on the heat conduction model

Analyzing the important nodes of complex systems by complex network theory can effectively solve the scientific bottlenecks in various aspects of these systems, and how to excavate important nodes has become a hot topic in complex network research. This paper proposes an algorithm for excavating important nodes based on the heat conduction model (HCM), which measures the importance of nodes by their output capacity. The number and importance of a node's neighbors are first used to determine its own capacity, its output capacity is then calculated based on the HCM while considering the network density, distance between nodes, and degree density of other nodes. The importance of the node is finally measured by the magnitude of the output capacity. The similarity experiments of node importance, sorting and comparison experiments of important nodes, and capability experiments of multi-node infection are conducted in nine real networks using the Susceptible-Infected-Removed model as the evaluation criteria. Further, capability experiments of multi-node infection are conducted using the Independent cascade model. The effectiveness of the HCM is demonstrated through a comparison with eight other algorithms for excavating important nodes.

Graded and sharp transitions in semantic function in left temporal lobe

Recent work has focussed on how patterns of functional change within the temporal lobe relate to whole-brain dimensions of intrinsic connectivity variation (Margulies et al., 2016). We examined two such 'connectivity gradients' reflecting the separation of (i) unimodal versus heteromodal and (ii) visual versus auditory-motor cortex, examining visually presented verbal associative and feature judgments, plus picture-based context and emotion generation. Functional responses along the first dimension sometimes showed graded change between modality-tuned and heteromodal cortex (in the verbal matching task), and other times showed sharp functional transitions, with deactivation at the extremes and activation in the middle of this gradient (internal generation). The second gradient revealed more visual than auditory-motor activation, regardless of content (associative, feature, context, emotion) or task process (matching/generation). We also uncovered subtle differences across each gradient for content type, which predominantly manifested as differences in relative magnitude of activation or deactivation.

How far We Go For Surgery: Distance to Pediatric Surgical Care in Indiana

INTRODUCTION

Despite increasing numbers of pediatric surgery training programs, access to pediatric surgical care remains limited in non-academic and rural settings. We aimed to characterize demographic and patient factors associated with increased distance to selected pediatric surgical procedures in Indiana.

METHODS

This IRB-approved retrospective review analyzed pediatric patients undergoing appendectomy, cholecystectomy, umbilical hernia repair, pyloromyotomy, and video assisted thoracic surgery (VATS) procedures from 2019 through 2021. Data was obtained from an electronic medical record warehouse and the Indiana Hospital Association. Travel distance was calculated as driving distance between patient address and hospital ZIP codes. Statistics were performed in R, with p < 0.05 indicating significance.

RESULTS

There were 6835 operations performed, and half of all operations (46%) were performed at institutions with fellowship-trained pediatric surgeons. The median travel distance for all operations was 13 miles (range 0-182); the shortest was for laparoscopic appendectomy (9 miles, IQR[0-20]). The longest distances were for pyloromyotomy (51 miles, IQR[14-84]) and VATS procedures (57 miles, IQR[13-111]), of which, nearly all were performed at tertiary pediatric care centers (97% and 93%, respectively). There was a significant linear and quadratic effect of age on travel distance (p < 0.001), with younger patients requiring farther travel. On multivariable linear regression, age and procedure type had the largest effect on travel distance (Eta squared 0.03, p < 0.001).

CONCLUSION

Younger age and more specialized procedures, including VATS and pyloromyotomy, were associated with increased travel distance. This highlights regionalization of these procedures to urban areas with pediatric care centers, while others are performed closer to home.

LEVEL OF EVIDENCE

III TYPE OF STUDY: Retrospective comparative study.

Scalable neighbour search and alignment with uvaia

Despite millions of SARS-CoV-2 genomes being sequenced and shared globally, manipulating such data sets is still challenging, especially selecting sequences for focused phylogenetic analysis. We present a novel method, uvaia, which is based on partial and exact sequence similarity for quickly extracting database sequences similar to query sequences of interest. Many SARS-CoV-2 phylogenetic analyses rely on very low numbers of ambiguous sites as a measure of quality since ambiguous sites do not contribute to single nucleotide polymorphism (SNP) differences. Uvaia overcomes this limitation by using measures of sequence similarity which consider partially ambiguous sites, allowing for more ambiguous sequences to be included in the analysis if needed. Such fine-grained definition of similarity allows not only for better phylogenetic analyses, but could also lead to improved classification and biogeographical inferences. Uvaia works natively with compressed files, can use multiple cores and efficiently utilises memory, being able to analyse large data sets on a standard desktop.

Chiropractic students' perception of remote learning during the COVID-19 pandemic

OBJECTIVE

To investigate chiropractic students' preferences and perceptions of remote learning with a secondary aim of comparing individuals with and without learning challenges.

METHODS

Following the mandatory period of remote education, a 33-question, mixed-methods, anonymous online survey was distributed from March to September 2021 to a single-campus chiropractic student body with an estimated sample study population of N = 1375. Demographic variables, self-reported learning challenges, technology skills, and perceptions of remote and on-ground learning delivery modalities were gathered. Percentages, measures of central tendency, and chi-square tests were performed on the data.

RESULTS

There were 117 participants (8.5%), of whom 63.2% were female (n = 74) and 87.2% (n = 102) were aged 18-34 years. Self-identified learning challenges were present in 33.3% (n = 39) of participants, of whom 28 stated they had attention-deficit/hyperactivity disorder or attention-deficit disorder. More than 85.5% (n = 100) of participants agreed they were proficient with the necessary technology. For basic science classes with a lecture and lab component, 61.5% (n = 72) preferred on-ground labs and remote lectures. Participants agreed that remote lectures and on-ground labs were a good use of time (75.2% [n = 88] and 79.5% [n = 93], respectively). There was a significant χ2 between individuals with and without learning challenges for the perception of "stimulating and interesting" (p = .044) and "attention" (p = .001) for on-ground lectures.

CONCLUSION

Chiropractic students preferred remote and on-ground education differentially for labs and lectures. On-ground labs provided greater perceived educational benefits; perceived benefits of remote lecture courses were only modestly supported. Students with self-identified learning challenges presented with some differences related to perception of on-ground lectures.

The impact of Medicaid expansion and travel distance on access to transplantation

Most transplant centers require candidates be insured before they can join the waitlist for a deceased donor organ. After the Affordable Care Act, many uninsured Americans gained improved access to Medicaid. I examine the effect of this increase in access to insurance and find that Medicaid expansions significantly increase Medicaid-insured waitlist registrations by 39% and deceased donor transplants received by 44%, but the increase in registrations is larger for candidates who live closer to a transplant center. Additionally I show that most of these registrations would have been privately insured otherwise but provide suggestive evidence that this is better explained by improved access to subsidized private coverage due to other ACA reforms than from candidates with private coverage before the ACA switching to Medicaid coverage after expansion. This suggests that although the ACA improved access to the transplantation system, access is still limited for candidates who live far from centers.

Immersive distance simulation: Exploring the educational impact of stereoscopic extended reality (XR) video in remote learning environments

What was the educational challenge?There is a growing need for healthcare simulation options when local expertise or resources are not available. To connect instructors with remote learners, current options for distance simulation are typically limited to videoconferencing on desktop computers or mobile devices, which may not fully capture the complexity of clinical scenarios.What was the solution?Extended reality (XR) technology may provide a more immersive and realistic distance healthcare simulation experience compared to traditional videoconferencing options. Unlike computer- or phone-based video calls, stereoscopic video in XR provides a sense of depth that may increase spatial understanding and engagement in distance simulation.How was the solution implemented?We investigated the impact of XR for synchronous distance simulation compared to traditional desktop-based videoconferencing in Emergency Medicine (EM) resident training for an obstetrical emergency. A randomized controlled experiment was conducted with half of the residents using XR and half using computers to participate in the simulation.What lessons were learned that are relevant to a wider global audience?There was an unanticipated interaction between postgraduate year and condition such that performance in the XR condition was superior for first year residents, while this was reversed for more experienced residents. This indicates that the benefits of XR might be dependent on participant characteristics, such as learner level.What are the next steps?We plan to extend this research to clarify characteristics of learners and tasks that are important determinants of differences in outcomes between stereoscopic XR versus traditional videoconference displays.

A modified method for precise anastomosis during laparoscopic low anterior resection for rectal cancer: the first clinical experience and application

BACKGROUND

There is no criterion to guide and evaluate the anastomosis of laparoscopic low anterior resection (LAR). We developed a new technique for precise anastomosis. This study endeavored to evaluate the effectiveness and safety of this new technology.

METHODS

Patients with mid-low rectal cancer who underwent laparoscopic LAR in our department were enrolled retrospectively between January 1, 2021 and July 1, 2023. During the LAR, the distance between the sacral promontory and the rectal stump was measured and used to determine the length of the sigmoid colon, which was preserved for anastomose. The demographic characteristics and short-term outcomes were analyzed.

RESULTS

Forty-nine patients (26 men, 23 women) with low and middle rectal cancer were retrospectively enrolled in the study. The distance of the tumor from the anal verge was 6.4 ± 2.7 cm. The operative time was 193 ± 42 min. All patients underwent precise anastomosis, among which 12 patients underwent freeing of the splenic flexure of the colon. According to our criteria, there was no redundant or tense state of the colon anterior to the sacrum after the anastomosis. Only one patient had a postoperative anastomotic leak (Grade B). All 15 patients receiving neoadjuvant chemoradiotherapy underwent terminal ileostomy. No postoperative death occurred within 30 days of the surgery. The median follow-up time in our study was 12 months. One patient developed a single metastasis in the right lobe of the liver in the eighth month after surgery and underwent microwave radiofrequency ablation, which did not recur in the four months of postoperative follow-up, and the rest of the patients survived disease-free without recurrence of metastasis.

CONCLUSIONS

Precise measurement of the proximal colon of the anastomosis can ensure accurate and convenient colorectal anastomosis and this may be a technique worthy of clinical application. However, its effectiveness needs to be further verified in a multicenter clinical trial.

Evaluation of a virtual practice placement: A model to increase student capacity

AIM

To describe the development and evaluation of a novel virtual practice placement.

BACKGROUND

Health systems around the world face the challenge of recruiting and retaining sufficient nursing staff to provide high quality care. The need to train more nurses makes it hard to provide sufficient and varied high quality student placements to all students. This paper reports the result of one approach to the provision of a novel virtual placement for pre-registration student nurses.

DESIGN

Online virtual placement evaluated by a questionnaire conducted after the placement.

METHODS

A total of 195 students attended the virtual practice placement between 10th October 2022 and the 10th March 2023. The survey consisted of eight questions, of which one invited a qualitative response.

RESULTS

A total of 188 students completed the questionnaire and provided feedback. Of these 84 were adult nursing students, 67 child, 36 mental health and one learning disability student. The virtual placement required considerable resources to run, however was deemed as valuable by most students. When asked to rate the overall experience out of 5, the median scores were consistently high: adult (Mdn=5), child (Mdn=4), learning disability (Mdn=5) and mental health (Mdn=5) and mean values consistently high across fields: adult (M=4.73), child (M=5), learning disability (M=5) and mental health (M=4.67). Qualitatively, there were four main themes that emerged from the questionnaire responses: increased understanding of community healthcare and holistic approaches to care; developing interpersonal skills; a positive impact on their future career opportunities and the value of realistic case studies.

CONCLUSIONS

Virtual placements are a viable addition to traditional placements. However, they require careful planning and considerable resources including experienced and dedicated facilitators. Principles for the delivery of virtual placements were produced to replicate and share best practice.

Adjusting the distance

This paper describes the anxiety evoked in a patient threatened by invasion or engulfment by his object on the one hand, and the fears of isolation and abandonment on the other. The author illustrates the patient's strugles to find a distance between himself and his object he can tolerate. The analyst has also to cope with the anxieties evoked by the patient's projections, and find a distance between himself and his patient that enables him to think and work.

Association Between Social Determinants of Health, Distance from Treatment Center, and Treatment Type with Outcomes in Human Papillomavirus Associated Oropharyngeal cancer

OBJECTIVES

Social determinants of health (SDOH) can influence access to cancer care, clinical trials, and oncologic outcomes. We investigated the association between SDOH, distance from treatment center, and treatment type with outcomes in human papillomavirus associated oropharyngeal squamous cell carcinoma [HPV(+)OPSCC] patients treated at a tertiary care center.

STUDY DESIGN

Retrospective review.

METHODS

HPV(+)OPSCC patients treated surgically from 2006 to 2021 were selected from our departmental Oropharyngeal Cancer RedCap database. Demographic data, treatment, and oncologic outcomes were extracted. Distance was calculated in miles between the centroid of each patient zip code and our hospital zip code (zipdistance).

RESULTS

874 patients (89 % male; mean age: 58 years) were identified. Most patients (96 %) reported Non-Hispanic White as their primary race. 204 patients (23 %) had a high-school degree or less, 217 patients (25 %) reported some college education or a 2-year degree, 153 patients (18 %) completed a four-year college degree, and 155 patients (18 %) had post-graduate degrees. Relative to those with a high-school degree, patients with higher levels of education were more likely to live further away from our institution (p < 0.0001). Patients who received adjuvant radiation therapy elsewhere lived, on average, 104 miles further away than patients receiving radiation at our institution (Estimate 104.3, 95 % CI 14.2-194.4, p-value = 0.02). In univariable Cox PH models, oncologic outcomes did not significantly differ by zipdistance.

CONCLUSIONS

Education level-and access to resources-varied proportionally to a patient's distance from our center. Patients travelling further distances for surgical management of OPSCC were more likely to pursue adjuvant radiation therapy at an outside institution. Distance traveled was not associated with oncologic outcomes. Breaking down barriers to currently excluded populations may improve access to clinical trials and improve oncologic outcomes for diverse patient populations.

Enhancing triage accuracy in emergency nurses: The impact of a game-based triage educational app

INTRODUCTION

Digital technology has enabled gamification methods to enhance triage education, reflecting an evolving healthcare landscape.

OBJECTIVE

To evaluate the effectiveness of a Gamification Triage Education App (GTEA) as a learning tool for emergency nurses, with a focus on creating an engaging and educationally effective platform for triage training.

METHOD

The GTEA was developed using no-code based software and expanded upon previous iterations, with added features such as points, rankings, instant feedback, and quest-based stories. From December 2021 to March 2022, 27 emergency room nurses from three hospitals in Korea were instructed to use GTEA for 100 min over the course of a week. The effects were measured before and after the intervention.

RESULTS

The results demonstrated a significant increase in triage accuracy from 4.3 ± 2.00 to 5.33 ± 1.47 (t = -2.18, p = 0.039), along with a substantial reduction in overtriage (t = 3.11, p = 0.004). Additionally, increases in critical thinking disposition, triage competency, and triage knowledge were observed (t = -3.11, p = 0.004; t = -2.72, p = 0.011; t = -3.14, p = 0.004, respectively).

CONCLUSIONS

The findings provide robust evidence for the effectiveness of gamification in triage training within emergency nursing.

EASIER: A new model for online learning of minimally invasive surgery skills

INTRODUCTION

Technology Enhanced Learning (TEL) can provide the tools to safely master minimally invasive surgery (MIS) skills in patient-free environments and receive immediate objective feedback without the constant presence of an instructor. However, TEL-based systems tend to work isolated from one another, focus on different skills, and fail to provide contents without a sound pedagogical background.

OBJECTIVE

The objective of this descriptive study is to present in detail EASIER, an innovative TEL platform for surgical and interventional training, as well as the results of its validation.

METHODS

EASIER provides a Learning Management System (LMS) for institutions and content creators that can connect and integrate TEL "external assets" (virtual reality simulators, augmented box trainers, augmented videos, etc.) addressing different skills. The platform integrates all skills under an Assessment Module that measures skills' progress in different courses. Finally, it provides content creators with a pedagogical model to scaffold contents while retaining flexibility to approach course design with different training philosophies in mind. Three courses were developed and hosted in the platform to validate it with end-users in terms of usability, performance, learning results in the courses and student self-perception on learning.

RESULTS

In total 111 volunteers completed the validation. The study was limited due to the COVID-19 pandemic, which limited access to external assets (virtual reality simulators). Nevertheless, usability was rated with 73.1 in the System Usability Scale. Most positive aspects on performance were easiness to access the platform, easiness to change the configuration and not requiring additional plug-ins to use the platform. The platform was rated above average in the six scales of the User Experience Questionnaire. Overall, student results improved significantly across the three courses (p < 0.05).

CONCLUSIONS

This study provides, within its limitations, evidence on the usefulness of the EASIER platform for distance learning of MIS skills. Results show the potential impact of the platform and are an encouraging boost for the future, especially in the aftermath of the COVID-19 pandemic.

Angiographic evaluation of the distance from the top of the jugular bulb to the inferior petrosal sinus-internal jugular vein junction: simple classification and identification method for the orifice of the non-visualized inferior petrosal sinus during neuroendovascular surgery

BACKGROUND

The inferior petrosal sinus (IPS) is the transvenous access route for neurointerventional surgery that is occasionally undetectable on digital subtraction angiography (DSA) because of blockage by a clot or collapse. This study was aimed at analyzing the distance from the jugular bulb (JB) to the IPS-internal jugular vein (IJV) junction and proposing a new anatomical classification system for the IPS-IJV junction to identify the non-visualized IPS orifice.

METHODS

DSA of 708 IPSs of 375 consecutive patients were retrospectively investigated to calculate the distance from the top of the JB to the IPS-IJV junction, and a simple classification system based on this distance was proposed.

RESULTS

The median distance from the top of the JB to the IPS-IJV junction was 20.8 ± 14.7 mm. Based on the lower (10.9 mm) and upper (31.1 mm) quartiles, IPS-IJV junction variants were: type I, 0-10 mm (22.3%); type II, 11-30 mm (45.8%); type III, > 31 mm (23.9%); and type IV, no connection to the IJV (8.0%). Bilateral distances showed a positive interrelationship, with a correlation coefficient of 0.86. The bilateral symmetry type (visualized IPSs bilaterally) according to our classification occurred in 267 of 300 (89.0%) patients.

CONCLUSIONS

In this study, the IPS-IJV junction was located far from the JB (types II and III), with a higher probability (69.6%). This distance and the four-type classification demonstrated high degrees of homology with the contralateral side. These results would be useful for identifying the non-visualized IPS orifice.

Antral Preservation in Sleeve Gastrectomy Appears to Protect Against Prolonged Vomiting and Gastroesophageal Reflux Disease. A Meta-Analysis of Randomized Controlled Trials

The optimal distance between the starting point of gastric transection and the pylorus during laparoscopic sleeve gastrectomy (LSG), which can be referred to as the distance from pylorus (DFP), is controversial. No consensus exist for what DFP is considered antral preservation, and what DFP is considered antral resection. Some surgeons prefer shorter DFP to maximize excess weight loss percentage (EWL%), while others prefer longer DFP because they believe that it shortens length of stay (LOS) and protects against leaks, prolonged vomiting, and gastroesophageal reflux disease (GERD). We sought to compare 6-cm DFP and 2-cm DFP in postoperative outcomes. In addition, we sought to evaluate the magnitude of any observed benefit through number needed to treat (NNT) analysis.

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.

The effectiveness of the using scenario and video in distance nursing education during COVID-19 pandemic

To determine the effects of using case scenarios and skill videos in distance education as a practical teaching-learning strategy on student satisfaction, professional perception, and professional values among nursing students during the COVID-19 pandemic. This is a quasi-experimental study with a one-group, pretest-post-test design. The study was conducted with 166 baccalaureate nursing students who attended online classes for 13 weeks, which included 80-minute theoretical and 120-minute practical training each week. A Student Information Form, the Student Satisfaction Scale-Short Form, the Nursing Profession Perception of Scale (NPPS), and the Nurses' Professional Values Scale-Revised (NPVS-R). We found significant differences between the students' pre- and post-test scores for the scales NPPS and the NPVS-R (p < .05), who attended online classes during the pandemic. However, our findings demonstrated that distance education had no effect on the level of student satisfaction (p > .05). The using case scenarios and skill videos in distance education as a strategy to deliver nursing course during the pandemic showed positive effects on the adoption of professional values and the perception about nursing profession among nursing students.

Patients' perspectives on the quality of online patient education materials: A qualitative study

BACKGROUND

Access to online patient education information can lead to more effective self-care and disease management. However, the large amount of online information provided through unknown or unreliable sources can challenge patients to trust and use this information. This study was designed to examine the opinions of Iranian gastrointestinal patients about the quality of online information used.

MATERIALS AND METHODS

A qualitative study was conducted using thematic analysis. Data were gathered via a semi-structured interview with 29 gastrointestinal patients, and data analysis was performed by qualitative content analysis using open coding with MAXQDA 2018 software.

RESULTS

Based on the study, 22 codes were extracted in nine subcategories named as: "Emphasis on the identity of providers," "Nature of online information," "Distrust on online information," "Poor quality of information," "Giving misinformation," "False impact," "Improve communication," "Positive effect on the patient," "Better Diagnosis."

CONCLUSIONS

In the current situation, Iranian patients are not confident enough about the quality of available online information. They believe that the use of current poor-quality information has negative consequences. However, they tend to use online patient education materials are produced in Persian by reputable scientific authorities. Using online information can increase patients' knowledge and lead to better communication with medical staff and other similar patients. They can use this information for self-care with more confidence, and such an approach can also have significant benefits for the national health system.

Becoming a Guest: On Proximity and Distance in Mental Health Home Treatment

Mental health home treatment is a service where patients with severe mental illnesses are visited by a multiprofessional psychiatric care team at their homes. In Germany, inpatient-equivalent home treatment as a specialized form of home treatment has been offered by hospitals since 2018. In its early stage, the shift of care activities out of the hospital toward the patient's home opened up a new set of problems and blurred the existing boundaries. This ethnographic study follows two home treatment teams and provides an in-depth description of their work. The findings are presented by three themes from our data analysis: (i) closeness and familiarity; (ii) bridging the distance; and (iii) tensions of proximity and distance. We then discuss the findings with the guiding lens of Becoming a Guest, which refers to the ambiguity of proximity and distance. The contribution for computer-supported cooperative work (CSCW) is twofold; on the one hand, we provide a detailed account of mental health home treatment, and on the other hand, we outline a conceptual model that helps to describe and analyze similar cases. We conclude the paper with directions for further research.