English Language Proficiency and Geographical Proximity to a Safety Net Clinic as a Predictor of Health Care Access

Studies suggest that proximity to a safety net clinic (SNC) promotes access to care among the uninsured. Distance-based barriers to care may be greater for people with limited English proficiency (LEP), compared to those who are English proficient (EP), but this has not been explored. We assessed the relationship between distance to the nearest SNC and access in non-rural uninsured adults in California, and examined whether this relationship differs by language proficiency. Using the 2005 California Health Interview Survey and a list we compiled of California’s SNCs, we calculated distance between uninsured interviewee residence and the exact address of the nearest SNC. Using multivariate regression to adjust for other relevant characteristics, we examined associations between this distance and interviewee’s probability of having a usual source of health care (USOC) and having visited a physician in the prior 12 months. To examine differences by language proficiency, we included interactions between distance and language proficiency. Uninsured LEP adults living within 2 miles of a SNC were 9.3% less likely than their EP counterparts to have a USOC (P = 0.046). Further, distance to the nearest SNC was inversely associated with the probability of having a USOC among LEP, but not among EP; consequently, the difference between LEP and EP in the probability of having a USOC widened with increasing distance to the nearest SNC. There was no difference between LEP and EP adults living within 2 miles of a SNC in likelihood of having a physician visit; however, as with USOC, distance to the nearest SNC was inversely associated with the probability of having a physician visit among LEP but not EP. The effect sizes diminished, but remained significant, when we included county fixed effects in the models. Having LEP is a barrier to health care access, which compounds when combined with increased distance to the nearest SNC, among uninsured adults. Future studies should explore potential mechanisms so that appropriate interventions can be implemented

Sutureless and stapleless laparoscopic splenectomy using radiofrequency - LigaSure device

Background: Bleeding is the main complication and cause of conversion during laparoscopic splenectomy (LS). We present the advantages of the LigaSure vessel sealing system added to the lateral approach for achieving safe vascular control. Methods: We performed 63 consecutive LS in a 3-year period using LigaSure in two affiliated university hospitals. We employed a right semilateral position technique with dissection of the spleen and vessel sealing using LigaSure. Forty-two patients had benign hematological disease, 19 had malignant disease, and two had splenic cysts. Results: A total of 58 LS were completed with five conversions due to hilar bleeding (three cases), difficult dissection (one), and massive splenomegaly (one). In all but five patients, blood loss was less than 100 ml. No transfusions were needed. There were five postoperative complications: portal thrombosis (one case), hemoperitoneum (two), surgical wound infection (one), and pleural effusion (one). Conclusions: The use of LigaSure, and the semilateral position, results in a gain of time and safety. Furthermore, average intraoperative bleeding is very low

Muon identification using multivariate techniques in the CMS experiment in proton-proton collisions at sqrt(s) = 13 TeV

An arXiv ePrint: arXiv:2310.03844v2 [hep-ex], is available online at: https://arxiv.org/abs/2310.03844v2 . Comments: Replaced with the published version. Added the journal reference and the DOI. All the figures and tables can be found at https://cms-results.web.cern.ch/cms-results/public-results/publications/MUO-22-001 (CMS Public Pages)The identification of prompt and isolated muons, as well as muons from heavy-flavour hadron decays, is an important task. We developed two multivariate techniques to provide highly efficient identification for muons with transverse momentum greater than 10 GeV. One provides a continuous variable as an alternative to a cut-based identification selection and offers a better discrimination power against misidentified muons. The other one selects prompt and isolated muons by using isolation requirements to reduce the contamination from nonprompt muons arising in heavy-flavour hadron decays. Both algorithms are developed using 59.7 fb-1 of proton-proton collisions data at a centre-of-mass energy of √(s)=13 TeV collected in 2018 with the CMS experiment at the CERN LHC.SCOAP3

Development of the CMS detector for the CERN LHC Run 3

A preprint version of this article is available at arXiv:2309.05466v1 [physics.ins-det], https://arxiv.org/abs/2309.05466v1 . Comments: Submitted to the Journal of Instrumentation. All figures and tables can be found at https://cms-results.web.cern.ch/cms-results/public-results/publications/PRF-21-001 (CMS Public Pages). Report number: CMS-PRF-21-001, CERN-EP-2023-136.Since the initial data taking of the CERN LHC, the CMS experiment has undergone substantial upgrades and improvements. This paper discusses the CMS detector as it is configured for the third data-taking period of the CERN LHC, Run 3, which started in 2022. The entire silicon pixel tracking detector was replaced. A new powering system for the superconducting solenoid was installed. The electronics of the hadron calorimeter was upgraded. All the muon electronic systems were upgraded, and new muon detector stations were added, including a gas electron multiplier detector. The precision proton spectrometer was upgraded. The dedicated luminosity detectors and the beam loss monitor were refurbished. Substantial improvements to the trigger, data acquisition, software, and computing systems were also implemented, including a new hybrid CPU/GPU farm for the high-level trigger.SCOAP3