Optimising spatial accessibility to inform rationalisation of specialist health services

BACKGROUND: In an era of budget constraints for healthcare services, strategies for provision of services that improve quality whilst saving costs are highly valued. A proposed means to achieve this is consolidation of services into fewer specialist centres, but this may lead to reduced spatial accessibility. We describe a methodology which includes implementing a combinatorial optimisation algorithm to derive combinations of services which optimise spatial accessibility in the context of service rationalisation, and demonstrate its use through the exemplar of tuberculosis clinics in London. METHODS: Our methodology involves (1) identifying the spatial distribution of the patient population using the service; (2) calculating patient travel times to each service location, and (3) using a combinatorial optimisation algorithm to identify subsets of locations that minimise overall travel time. We estimated travel times for tuberculosis patients notified in London between 2010 and 2013 to each of 29 clinics in the city. Travel time estimates were derived from the Transport for London Journey Planner service. We identified the subset of clinics that would provide the shortest overall travel time for each possible number of clinic subsets (1-28). RESULTS: Based on the 29 existing clinic locations, mean estimated travel time to clinics used by 12,061 tuberculosis patients in London was 33 min; and mean time to their nearest clinics was 28 min. Using optimum combinations of clinic locations, and assuming that patients attended their nearest clinics, a mean travel time of less than 45 min could be achieved with three clinics; of 34 min with ten clinics, and of less than 30 min with 18 clinics. CONCLUSIONS: We have developed a methodological approach to optimise spatial accessibility which can be used to inform rationalisation of health services. In urban conurbations, this may enable service reorganisation which increases quality and efficiency without substantially affecting spatial accessibility. This approach could be used to inform planning of service reorganisations, but may not be generalisable to rural areas or smaller urban centres

Spatial methods for infectious disease outbreak investigations: systematic literature review

Investigations of infectious disease outbreaks are conventionally framed in terms of person, time and place. Although geographic information systems have increased the range of tools available, spatial analyses are used relatively infrequently. We conducted a systematic review of published reports of outbreak investigations worldwide to estimate the prevalence of spatial methods, describe the techniques applied and explore their utility. We identified 80 reports using spatial methods published between 1979 and 2013, ca 0.4% of the total number of published outbreaks. Environmental or waterborne infections were the most commonly investigated, and most reports were from the United Kingdom. A range of techniques were used, including simple dot maps, cluster analyses and modelling approaches. Spatial tools were usefully applied throughout investigations, from initial confirmation of the outbreak to describing and analysing cases and communicating findings. They provided valuable insights that led to public health actions, but there is scope for much wider implementation and development of new methods.</jats:p

ANTHROPOMETRIC AND PHYSICAL FITNESS PROFILES OF YOUTH ATHLETES

Mason Thieu1, Quincy R. Johnson1,Yang Yang1, Dayton Sealey2, Clay Frels2, Dimitrije Cabarkapa1, & Andrew C. Fry1, FACSM 1University of Kansas, Lawrence, Kansas; 2Department of Kinesiology and Sport Science, University of Nebraska at Kearney, Kearney, Nebraska Youth sports participation, competitiveness, and training intensity continues to increase. However, more information is needed regarding the anthropometric and physical fitness profile of today’s youth athletes. Common strategies for profiling anthropometric and physical fitness characteristics of athletes across their lifespan include the sit and reach (SR), functional movement screen (FMS), isometric mid-thigh pull (IMTP), and the countermovement jump (CMJ) tests. PURPOSE: This study aimed to assess SR, FMS, IMTP, and CMJ performance of youth athletes. METHODS: Youth athletes participating in a community-based strength and conditioning program (male; n=15, age=10.7±0.9, height=157.7±9.2cm, weight=53.2±14.3kg, female; n=6, age=10.2±0.4, height=146.9±8.7cm, weight=40.4±8.2kg) participated in this study. Each athlete performed a SR test, FMS test, two maximum effort IMTPs, and two maximum effort CMJs. Mann-Whitney U Tests (p\u3c0.05) were performed using sex as the grouping variable. RESULTS: Among the variables analyzed, significant differences were found in SR performance (p=0.026), FMS total score (p=0.018), IMTP peak force (p=0.006), and CMJ peak propulsive power (p=0.016) between sexes. The mean ± SD is reported in Table 1. CONCLUSION: Significant differences in anthropometric and physical fitness were observed between male and female youth athletes. While sex differences in anthropometrics have been well reported, the present study provides novel insights on physical fitness data measuring muscular strength and power for youth athletes. These findings can be utilized by coaches, physical educators, strength and conditioning professionals, and sport scientists to better understand the youth athlete population and contribute to their long-term development of athletic qualities

Characterization of Corrosion in Aluminum Alloys Using Nuclear Magnetic Resonance

With an ever increasing emphasis on extending the life of both military and commercial aircraft, it is critical to have nondestructive evaluation (NDE) methods capable of detecting corrosion in its earliest stages of formation. The consequences of corrosion left undetected are material thinning and a subsequent reduction in strength. Conventional NDE methods such as ultrasonics, eddy current and radiography are capable of detecting the resultant exfoliation caused by corrosion; however, some material loss must occur before reliable detection can be made using the referenced methods

Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014

An outbreak of isoniazid-resistant tuberculosis first identified in London has now been ongoing for 20 years, making it the largest drug-resistant outbreak of tuberculosis documented to date worldwide. We identified culture-confirmed cases with indistinguishable molecular strain types and extracted demographic, clinical, microbiological and social risk factor data from surveillance systems. We summarised changes over time and used kernel-density estimation and k-function analysis to assess geographic clustering. From 1995 to 2014, 508 cases were reported, with a declining trend in recent years. Overall, 70% were male (n = 360), 60% born in the United Kingdom (n = 306), 39% white (n = 199), and 26% black Caribbean (n = 134). Median age increased from 25 years in the first 5 years to 42 in the last 5. Approximately two thirds of cases reported social risk factors: 45% drug use (n = 227), 37% prison link (n = 189), 25% homelessness (n = 125) and 13% alcohol dependence (n = 64). Treatment was completed at 12 months by 52% of cases (n = 206), and was significantly lower for those with social risk factors (p < 0.05), but increased over time for all patients (p < 0.05). The outbreak remained focused in north London throughout. Control of this outbreak requires continued efforts to prevent and treat further active cases through targeted screening and enhanced case management

VALIDATION OF A 3-DIMENSIONAL VIDEO MOTION CAPTURE SYSTEM FOR DETERMINING BARBELL POWER AND VELOCITY DURING THE BENCH PRESS

Andrew C. Fry, Luke Bradford, Trent Herda, Joseph Weir FACSM, Michael Lane, Matthew Andre, Andrea Hudy, J. Deckert and J. Siedlik.Neuromechanics Laboratory and Kansas Athletics Inc., University of Kansas, Lawrence, KS Analyses of barbell kinetics and kinematics have typically required the use of force plates, tether-based position transducers, or digitized video analysis. PURPOSE: To determine the validity of a 3-dimensional video markerless motion capture system for determining barbell kinetics and kinematics. METHODS: Two 3-D video cameras sampling at 30 Hz and mounted on the top of a power rack were interfaced with a self-contained computer and software system, and operated with a touch screen (EliteForm, Lincoln, NE). For laboratory comparison purposes, a ceiling–mounted linear position transducer (Unimeasure, Corvallis, OR) was attached via a tether to the barbell. Data from the position transducer was sampled at 1000 Hz using a BioPac data acquisition system (Goleta, CA). Velocity (m.s-1) and power (W) were derived using LabView software (National Instruments, Austin, TX). One weight-trained male subject (age = 25 yrs, hgt = 1.75 m, BW = 82.6 kg, 1 RM = 161.0 kg) performed the barbell bench press exercise for 10 sets x 1 repetition at 30, 40, 50, 60, 70 and 80% 1 RM loads using maximal acceleration during the concentric phase. Dependent variables included peak (PV) and X̅ velocity (MV) and peak (PP) and X̅ power (MP). Linear regressions between lab-derived and 3-D video-derived data provided correlation coefficients, and regression slopes (b). Bland-Altman plots were used to determine X̅ differences, from which effect sizes (Cohen’s D) and % error for the 3-D camera system was determined. RESULTS: Lab-derived mean values for all loads ranged as follows; MV = 0.36 – 1.00 m.s-1, PV = 0.47 – 1.60 m.s-1, MP = 460.9 – 621.6 W, and PP = 619.9 – 1055.6 W. CONCLUSION: The 3-D video markerless motion capture system provided accurate and valid barbell velocity and power data for the bench press exercise. Supported in part by Nebraska Global LL

Probabilistic, spinally-gated control of bladder pressure and autonomous micturition by Barrington’s nucleus CRH neurons

Micturition requires precise control of bladder and urethral sphincter via parasympathetic, sympathetic and somatic motoneurons. This involves a spino-bulbospinal control circuit incorporating Barrington’s nucleus in the pons (Barr). Ponto-spinal glutamatergic neurons that express corticotrophin-releasing hormone (CRH) form one of the largest Barr cell populations. BarrCRH neurons can generate bladder contractions, but it is unknown whether they act as a simple switch or provide a high-fidelity pre-parasympathetic motor drive and whether their activation can actually trigger voids. Combined opto- and chemo-genetic manipulations along with multisite extracellular recordings in urethane anaesthetised CRHCre mice show that BarrCRH neurons provide a probabilistic drive that generates co-ordinated voids or non-voiding contractions depending on the phase of the micturition cycle. CRH itself provides negative feedback regulation of this process. These findings inform a new inferential model of autonomous micturition and emphasise the importance of the state of the spinal gating circuit in the generation of voiding

ReadNet: A Hierarchical Transformer Framework for Web Article Readability Analysis

Analyzing the readability of articles has been an important sociolinguistic task. Addressing this task is necessary to the automatic recommendation of appropriate articles to readers with different comprehension abilities, and it further benefits education systems, web information systems, and digital libraries. Current methods for assessing readability employ empirical measures or statistical learning techniques that are limited by their ability to characterize complex patterns such as article structures and semantic meanings of sentences. In this paper, we propose a new and comprehensive framework which uses a hierarchical self-attention model to analyze document readability. In this model, measurements of sentence-level difficulty are captured along with the semantic meanings of each sentence. Additionally, the sentence-level features are incorporated to characterize the overall readability of an article with consideration of article structures. We evaluate our proposed approach on three widely-used benchmark datasets against several strong baseline approaches. Experimental results show that our proposed method achieves the state-of-the-art performance on estimating the readability for various web articles and literature.Comment: ECIR 202

Survey of the quality of experimental design, statistical analysis and reporting of research using animals

For scientific, ethical and economic reasons, experiments involving animals should be appropriately designed, correctly analysed and transparently reported. This increases the scientific validity of the results, and maximises the knowledge gained from each experiment. A minimum amount of relevant information must be included in scientific publications to ensure that the methods and results of a study can be reviewed, analysed and repeated. Omitting essential information can raise scientific and ethical concerns. We report the findings of a systematic survey of reporting, experimental design and statistical analysis in published biomedical research using laboratory animals. Medline and EMBASE were searched for studies reporting research on live rats, mice and non-human primates carried out in UK and US publicly funded research establishments. Detailed information was collected from 271 publications, about the objective or hypothesis of the study, the number, sex, age and/or weight of animals used, and experimental and statistical methods. Only 59% of the studies stated the hypothesis or objective of the study and the number and characteristics of the animals used. Appropriate and efficient experimental design is a critical component of high-quality science. Most of the papers surveyed did not use randomisation (87%) or blinding (86%), to reduce bias in animal selection and outcome assessment. Only 70% of the publications that used statistical methods described their methods and presented the results with a measure of error or variability. This survey has identified a number of issues that need to be addressed in order to improve experimental design and reporting in publications describing research using animals. Scientific publication is a powerful and important source of information; the authors of scientific publications therefore have a responsibility to describe their methods and results comprehensively, accurately and transparently, and peer reviewers and journal editors share the responsibility to ensure that published studies fulfil these criteria