Quantitative measurements of inequality in geographic accessibility to pediatric care in Oita Prefecture, Japan: Standardization with complete spatial randomness

<p>Abstract</p> <p>Background</p> <p>A quantitative measurement of inequality in geographic accessibility to pediatric care as well as that of mean distance or travel time is very important for priority setting to ensure fair access to pediatric facilities. However, conventional techniques for measuring inequality is inappropriate in geographic settings. Since inequality measures of access distance or travel time is strongly influenced by the background geographic distribution patterns, they cannot be directly used for regional comparisons of geographic accessibility. The objective of this study is to resolve this issue by using a standardization approach.</p> <p>Methods</p> <p>Travel times to the nearest pediatric care were calculated for all children in Oita Prefecture, Japan. Relative mean differences were considered as the inequality measure for secondary medical service areas, and were standardized with an expected value estimated from a Monte Carlo simulation based on complete spatial randomness.</p> <p>Results</p> <p>The observed mean travel times in the area considered averaged 4.50 minutes, ranging from 1.83 to 7.02 minutes. The mean of the observed inequality measure was 1.1, ranging from 0.9 to 1.3. The expected values of the inequality measure varied according to the background geographic distribution pattern of children, which ranged from 0.3 to 0.7. After standardizing the observed inequality measure with the expected one, we found that the ranks of the inequality measure were reversed for the observed areas.</p> <p>Conclusions</p> <p>Using the indicator proposed in this paper, it is possible to compare the inequality in geographic accessibility among regions. Such a comparison may facilitate priority setting in health policy and planning.</p

Optimizing the two-step floating catchment area method for measuring spatial accessibility to medical clinics in Montreal

<p>Abstract</p> <p>Background</p> <p>Reducing spatial access disparities to healthcare services is a growing priority for healthcare planners especially among developed countries with aging populations. There is thus a pressing need to determine which populations do not enjoy access to healthcare, yet efforts to quantify such disparities in spatial accessibility have been hampered by a lack of satisfactory measurements and methods. This study compares an optimised and the conventional version of the two-step floating catchment area (2SFCA) method to assess spatial accessibility to medical clinics in Montreal.</p> <p>Methods</p> <p>We first computed catchments around existing medical clinics of Montreal Island based on the shortest network distance. Population nested in dissemination areas were used to determine potential users of a given medical clinic. To optimize the method, medical clinics (supply) were weighted by the number of physicians working in each clinic, while the previous year's medical clinic users were computed by ten years age group was used as weighting coefficient for potential users of each medical clinic (demand).</p> <p>Results</p> <p>The spatial accessibility score (SA) increased considerably with the optimisation method. Within a distance of 1 Km, for instance, the maximum clinic accessible for 1,000 persons is 2.4 when the conventional method is used, compared with 27.7 for the optimized method. The t-test indicates a significant difference between the conventional and the optimized 2SFCA methods. Also, results of the differences between the two methods reveal a clustering of residuals when distance increases. In other words, a low threshold would be associated with a lack of precision.</p> <p>Conclusion</p> <p>Results of this study suggest that a greater effort must be made ameliorate spatial accessibility to medical clinics in Montreal. To ensure that health resources are allocated in the interest of the population, health planners and the government should consider a strategy in the sitting of future clinics which would provide spatial access to the greatest number of people.</p

High elevation watersheds in the southern Appalachians: Indicators of sensitivity to acidic deposition and the potential for restoration through liming

Southern Appalachian high elevation watersheds have deep rocky soils with high organic matter content, different vegetation communities, and receive greater inputs of acidic deposition compared to low elevation sites within the region. Since the implementation of the Clean Air Act Amendment in the 1990s, concentrations of acidic anions in rainfall have declined. However, some high elevation streams continue to show signs of chronic to episodic acidity, where acid neutralizing capacity (ANC) ranges from 0 to 20 µeq L-1. We studied three 3rd order watersheds (North River in Cherokee National Forest, Santeetlah Creek in Nantahala National Forest, and North Fork of the French Broad in Pisgah National Forest) and selected four to six 1st order catchments within each watershed to represent a gradient in elevation (849–1526 m) and a range in acidic stream ANC values (11–50 leq L-1). Our objectives were to (1) identify biotic, physical and chemical catchment parameters that could be used as indices of stream ANC, pH and Ca:Al molar ratios and (2) estimate the lime required to restore catchments from the effects of excess acidity and increase base cation availability. We quantified each catchment’s biotic, physical, and chemical characteristics and collected stream, O-horizon, and mineral soil samples for chemical analysis seasonally for one year. Using repeated measures analysis, we examined variability in stream chemistry and catchment characteristics; we used a nested split-plot design to identify catchment characteristics that were correlated with stream chemistry. Watersheds differed significantly and the catchments sampled provided a wide range of stream chemical, biotic, physical and chemical characteristics. Variability in stream ANC, pH, and Ca:Al molar ratio were significantly correlated with catchment vegetation characteristics (basal area, tree height, and tree diameter) as well as O-horizon nitrogen and aluminum concentrations. Total soil carbon and calcium (an indicator of parent material), were significant covariates for stream ANC, pH and Ca:Al molar ratios. Lime requirement estimates did not differ among watersheds but this data will help select catchments for future restoration and lime application studies. Not surprisingly, this work found many vegetation and chemical characteristics that were useful indicators of stream acidity. However, some expected relationships such as concentrations of mineral soil extractable Ca and SO4 were not significant. This suggests that an extensive test of these indicators across the southern Appalachians will be required to identify high elevation forested catchments that would benefit from restoration activities

Neurostimulatory and ablative treatment options in major depressive disorder: a systematic review

Introduction Major depressive disorder is one of the most disabling and common diagnoses amongst psychiatric disorders, with a current worldwide prevalence of 5-10% of the general population and up to 20-25% for the lifetime period. Historical perspective Nowadays, conventional treatment includes psychotherapy and pharmacotherapy; however, more than 60% of the treated patients respond unsatisfactorily, and almost one fifth becomes refractory to these therapies at long-term follow-up. Nonpharmacological techniques Growing social incapacity and economic burdens make the medical community strive for better therapies, with fewer complications. Various nonpharmacological techniques like electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, lesion surgery, and deep brain stimulation have been developed for this purpose. Discussion We reviewed the literature from the beginning of the twentieth century until July 2009 and described the early clinical effects and main reported complications of these methods. © The Author(s) 2010.Link_to_subscribed_fulltex

A Microhomology-Mediated Break-Induced Replication Model for the Origin of Human Copy Number Variation

Chromosome structural changes with nonrecurrent endpoints associated with genomic disorders offer windows into the mechanism of origin of copy number variation (CNV). A recent report of nonrecurrent duplications associated with Pelizaeus-Merzbacher disease identified three distinctive characteristics. First, the majority of events can be seen to be complex, showing discontinuous duplications mixed with deletions, inverted duplications, and triplications. Second, junctions at endpoints show microhomology of 2–5 base pairs (bp). Third, endpoints occur near pre-existing low copy repeats (LCRs). Using these observations and evidence from DNA repair in other organisms, we derive a model of microhomology-mediated break-induced replication (MMBIR) for the origin of CNV and, ultimately, of LCRs. We propose that breakage of replication forks in stressed cells that are deficient in homologous recombination induces an aberrant repair process with features of break-induced replication (BIR). Under these circumstances, single-strand 3′ tails from broken replication forks will anneal with microhomology on any single-stranded DNA nearby, priming low-processivity polymerization with multiple template switches generating complex rearrangements, and eventual re-establishment of processive replication

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

The biogeochemistry of sulfur at Hubbard Brook

A synthesis of the biogeochemistry of S was done during 34 yr (1964-1965 to 1997-1998) in reference and human-manipulated forest ecosystems of the Hubbard Brook Experimental Forest (HBEF), NH. There have been significant declines in concentration (-0.44 mumol/liter-yr) and input (-5.44 mol/ha-yr) of SO42- in atmospheric bulk wet deposition, and in concentration (-0.64 mumol/liter-yr) and output (-3.74 mol/ha-yr) of SO42- in stream water of the HBEF since 1964. These changes are strongly correlated with concurrent decreases in emissions of SO2 from the source area for the HBEF. The concentration and input of SO42- in bulk deposition ranged from a low of 13.1 mumol/liter (1983-1984) and 211 mol/ha-yr (1997-1998) to a high of 34.7 mumol/liter (1965-1966) and 479 mol/ha-yr (1967-1968), with a long-term mean of 23.9 mumol/liter and 336 mol/ha-yr during 1964-1965 to 1997-1998. Despite recent declines in concentrations, SO42- is the dominant anion in both bulk deposition and stream water at HBEF. Dry deposition is difficult to measure, especially in mountainous terrain, but was estimated at 21% of bulk deposition. Thus, average total atmospheric deposition was 491 and 323 mol/ha-yr during 1964-1969 and 1993-1998, respectively. Based on the long-term delta(34)S pattern associated with anthropogenic emissions, SO42- deposition at HBEF is influenced by numerous SO 2 sources, but biogenic sources appear to be small. Annual throughfall plus stemflow in 1993-1994 was estimated at 346 mol SO42-/ha. Aboveground litterfall, for the watershed-ecosystem averaged about 180 mol S/ha-yr, with highest inputs (190 mol S/ha-yr) in the lower elevation, more deciduous forest zone. Weathering release was calculated at a maximum of 50 mol S/ha-yr. The concentration and output of SO4 2– in stream water ranged from a low of 42.3µmol/liter (1996–1997) and 309 mol/ha-yr(1964–1965), to a high of 66.1 µmol/liter(1970–1971) and 849 mol/ha-yr (1973–1974), with along-term mean of 55.5 µmol/liter and 496mol/ha-yr during the 34 yrs of study. Gross outputs ofSO4 2– in stream water consistently exceeded inputsin bulkdeposition and were positively and significantly related to annualprecipitationand streamflow. The relation between gross SO4 2–output and annual streamflow changed with time asatmospheric inputs declined. In contrast to the pattern for bulk depositionconcentration, there was no seasonal pattern for streamSO4 2– concentration. Nevertheless, stream outputs ofSO4 2– were highly seasonal, peaking during springsnowmelt, andproducing a monthly cross-over pattern where net hydrologic flux (NHF) ispositive during summer and negative during the remainder of the year. Nosignificant elevational pattern in streamwaterSO4 2– concentration was observed. Mean annual,volume-weightedsoil water SO4 2– concentrations were relativelyuniform by soil horizon andacross landscape position. Based upon isotopic evidence, much of theSO4 2– entering HBEF in atmospheric depositioncycles throughvegetation and microbial biomass before being released to the soil solution andstream water. Gaseous emissions of S from watershed-ecosystems at HBEF areunquantified, but estimated to be very small. Organic S (carbon bonded andestersulfates) represents some 89% of the total S in soil at HBEF. Some 6% exists asphosphate extractable SO4 2– (PSO4).About 73% of the total S in the soilprofile at HBEF occurs in the Bs2 horizon, and some 9% occurs in the forestfloor. The residence time for S in the soil was calculated to be sim9 yr, butonly a small portion of the total organic soil pool turns over relativelyquickly. The S content of above- and belowground biomass is about 2885mol/ha, of which some 3–5% is in standing dead trees. Yellowbirch, American beech and sugar maple accounted for 89% of the S in trees, with31% in branches, 27% in roots and 25% in the lightwood of boles. The pool of Sin living biomass increased from 1965 to 1982 due to biomass accretion, andremained relatively constant thereafter. Of current inputs to the availablenutrient compartment of the forest ecosystem, 50% is from atmospheric bulkdeposition, 24% from net soil release, 11% from dry deposition, 11% from rootexudates and 4% is from canopy leaching. Comparing ecosystem processes for Sfrom 1964–1969 to 1993–1998, atmospheric bulk deposition decreasedby 34%, stream output decreased by 10%, net annual biomass storage decreased by92%, and net soil release increased by 184% compared to the 1964–1969values. These changes are correlated with decreased emissions of SO2from the source area for the HBEF. Average, annual bulk deposition inputsexceeded streamwater outputs by 160.0 ± 75.3 SD molS/ha-yr,but average annual net ecosystem fluxes (NEF) were much smaller, mostlynegativeand highly variable during the 34 yr period (–54.3 ± 72.9 SDmol S/ha-yr; NEF range, +86.8 to –229.5). While severalmechanisms may explain this small discrepancy, the most likely are netdesorption of S and net mineralization of organic S largely associated with theforest floor. Our best estimates indicate that additional S from dry depositionand weathering release is probably small and that desorption accounts for about37% of the NEF imbalance and net mineralization probably accounts for theremainder (sim60%). Additional inputs from dry deposition would result fromunmeasured inputs of gaseous and particulate deposition directly to the forestfloor. The source of any unmeasured S input has important implications for therecovery of soils and streams in response to decreases in inputs of acidicdeposition. Sulfate is a dominant contributor to acid deposition at HBEF,seriously degrading aquatic and terrestrial ecosystems. Because of the strongrelation between SO2 emissions and concentrations ofSO4 2– in both atmospheric deposition and streamwater at HBEF,further reductions in SO2 emissions will be required to allowsignificant ecosystem recovery from the effects of acidic deposition. Thedestruction or removal of vegetation on experimental watershed-ecosystems atHBEF resulted in increased rates of organic matter decomposition andnitrification, a lowering of soil and streamwater pH, enhancedSO4 2– adsorption on mineral soil and smallerconcentrations andlosses of SO4 2– in stream water. With vegetationregrowth, this adsorbedSO4 2– is released from the soil, increasingconcentrations andfluxes of SO4 2– in drainage water. Streamwaterconcentration ofSO4 2– and gross annual output ofSO4 2–/ha are essentially the same throughout theHubbard BrookValley in watersheds varying in size by about 4 orders of magnitude, from 3 to3000 ha