Accessibility to health care facilities in Montreal Island: an application of relative accessibility indicators from the perspective of senior and non-senior residents

<p>Abstract</p> <p>Background</p> <p>Geographical access to health care facilities is known to influence health services usage. As societies age, accessibility to health care becomes an increasingly acute public health concern. It is known that seniors tend to have lower mobility levels, and it is possible that this may negatively affect their ability to reach facilities and services. Therefore, it becomes important to examine the mobility situation of seniors vis-a-vis the spatial distribution of health care facilities, to identify areas where accessibility is low and interventions may be required.</p> <p>Methods</p> <p>Accessibility is implemented using a cumulative opportunities measure. Instead of assuming a fixed bandwidth (i.e. a distance threshold) for measuring accessibility, in this paper the bandwidth is defined using model-based estimates of average trip length. Average trip length is an all-purpose indicator of individual mobility and geographical reach. Adoption of a spatial modelling approach allows us to tailor these estimates of travel behaviour to specific locations and person profiles. Replacing a fixed bandwidth with these estimates permits us to calculate customized location- and person-based accessibility measures that allow inter-personal as well as geographical comparisons.</p> <p>Data</p> <p>The case study is Montreal Island. Geo-coded travel behaviour data, specifically average trip length, and relevant traveller's attributes are obtained from the Montreal Household Travel Survey. These data are complemented with information from the Census. Health care facilities, also geo-coded, are extracted from a comprehensive business point database. Health care facilities are selected based on Standard Industrial Classification codes 8011-21 (Medical Doctors and Dentists).</p> <p>Results</p> <p>Model-based estimates of average trip length show that travel behaviour varies widely across space. With the exception of seniors in the downtown area, older residents of Montreal Island tend to be significantly less mobile than people of other age cohorts. The combination of average trip length estimates with the spatial distribution of health care facilities indicates that despite being more mobile, suburban residents tend to have lower levels of accessibility compared to central city residents. The effect is more marked for seniors. Furthermore, the results indicate that accessibility calculated using a fixed bandwidth would produce patterns of exposure to health care facilities that would be difficult to achieve for suburban seniors given actual mobility patterns.</p> <p>Conclusions</p> <p>The analysis shows large disparities in accessibility between seniors and non-seniors, between urban and suburban seniors, and between vehicle owning and non-owning seniors. This research was concerned with potential accessibility levels. Follow up research could consider the results reported here to select case studies of actual access and usage of health care facilities, and related health outcomes.</p

A microstructured fiber with defined borosilicate regions to produce a radial micronozzle array for nanoelectrospray ionization

This work highlights the possibility of using microstructured fibres with predefined doped regions to produce functional microstructures at a fibre facet with differential chemical etching. A specially designed silica microstructured fibre (MSF) that possesses specific boron-doped silica regions was fabricated for the purpose of generating a radial micronozzle array. The MSF was drawn from a preform comprising pure silica capillaries surrounded by boron-doped silica rods. Different etching rates of the boron-doped and silica regions at the fiber facet produces raised nozzles where the silica capillaries were placed. Fabrication parameters were explored in relation to the fidelity and protrusion length of the nozzle. Using etching alone, the nozzle protrusion length was limited, and the inner diameter of the channels in the array is expanded. However with the addition of a protective water counter flow, nozzle protrusion is increased to 60 μm with a limited increase in hole diameter. The radial micronozzle array generated nine individual electrosprays which were characterized using spray current measurements and related to theoretical prediction. Signal enhancement for the higher charge state ions for two peptides showed a substantial signal enhancement compared to conventional emitter technology.Y. Fu, S. Morency, K. Bachus, D. Simon, T. Hutama, G. T. T. Gibson, Y. Messaddeq and R. D. Oleschu

High Altitude Aerial Natural Gas Leak Detection System

The objective of this program was to develop and demonstrate a cost-effective and power-efficient advanced standoff sensing technology able to detect and quantify, from a high-altitude (&gt; 10,000 ft) aircraft, natural gas leaking from a high-pressure pipeline. The advanced technology is based on an enhanced version of the Remote Methane Leak Detector (RMLD) platform developed previously by Physical Sciences Inc. (PSI). The RMLD combines a telecommunications-style diode laser, fiber-optic components, and low-cost DSP electronics with the well-understood principles of Wavelength Modulation Spectroscopy (WMS), to indicate the presence of natural gas located between the operator and a topographic target. The transceiver transmits a laser beam onto a topographic target and receives some of the laser light reflected by the target. The controller processes the received light signal to deduce the amount of methane in the laser's path. For use in the airborne platform, we modified three aspects of the RMLD, by: (1) inserting an Erbium-doped optical fiber laser amplifier to increase the transmitted laser power from 10 mW to 5W; (2) increasing the optical receiver diameter from 10 cm to 25 cm; and (3) altering the laser wavelength from 1653 nm to 1618 nm. The modified RMLD system provides a path-integrated methane concentration sensitivity {approx}5000 ppm-m, sufficient to detect the presence of a leak from a high capacity transmission line while discriminating against attenuation by ambient methane. In ground-based simulations of the aerial leak detection scenario, we demonstrated the ability to measure methane leaks within the laser beam path when it illuminates a topographic target 2000 m away. We also demonstrated simulated leak detection from ranges of 200 m using the 25 cm optical receiver without the fiber amplifier

Dynamic behavior analysis via structured rank minimization

Human behavior and affect is inherently a dynamic phenomenon involving temporal evolution of patterns manifested through a multiplicity of non-verbal behavioral cues including facial expressions, body postures and gestures, and vocal outbursts. A natural assumption for human behavior modeling is that a continuous-time characterization of behavior is the output of a linear time-invariant system when behavioral cues act as the input (e.g., continuous rather than discrete annotations of dimensional affect). Here we study the learning of such dynamical system under real-world conditions, namely in the presence of noisy behavioral cues descriptors and possibly unreliable annotations by employing structured rank minimization. To this end, a novel structured rank minimization method and its scalable variant are proposed. The generalizability of the proposed framework is demonstrated by conducting experiments on 3 distinct dynamic behavior analysis tasks, namely (i) conflict intensity prediction, (ii) prediction of valence and arousal, and (iii) tracklet matching. The attained results outperform those achieved by other state-of-the-art methods for these tasks and, hence, evidence the robustness and effectiveness of the proposed approach

Are transit trips symmetrical in time and space? Evidence from the Twin Cities

This study exploits electronic fare collection data to examine the symmetry of boardings and alightings along a transit route. The symmetry of boardings and alightings is arguably the most important concept in the estimation of travel distances such as average trip lengths and passenger miles from data from entry-only fare collection systems. The paper shows the ways such data can be used to examine the symmetry of boardings and alightings through travel patterns in spatial and temporal dimensions. A novel method for aggregating stops, especially for the nearest stops in the opposite direction, is used to compare boardings in one direction with alightings in the opposite direction. Spatially, the method allows examination of the characteristics of boardings and alightings in a spatial dimension. Temporally, the method examines whether a specific and symmetric passenger flow is observed between specific periods (e.g., between morning and afternoon peaks). A case study of the Minneapolis-Saint Paul, Minnesota, region is performed by using automatically collected data from Metro Transit. Automatic fare collection data reveal considerable variation in passenger flow between specific periods. The use of automated passenger-counting data shows this variation to be statistically significant when both temporal and spatial symmetry are examined on an individual day

Detection of delirium by nurses among long-term care residents with dementia

<p>Abstract</p> <p>Background</p> <p>Delirium is a prevalent problem in long-term care (LTC) facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected among demented older residents in LTC settings. The goals of this study were to determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium.</p> <p>Methods</p> <p>In this prospective study (N = 156), nurse ratings of delirium were compared to researcher ratings of delirium. This procedure was repeated for 6 delirium symptoms. Sensitivity, specificity, positive and negative predictive values were computed. Logistic regressions were conducted to identify factors associated with delirium that is undetected by nurses.</p> <p>Results</p> <p>Despite a high prevalence of delirium in this cohort (71.5%), nurses were able to detect the delirium in only a minority of cases (13%). Of the 134 residents not identified by nurses as having delirium, only 29.9% of them were correctly classified. Detection rates for the 6 delirium symptoms varied between 39.1% and 58.1%, indicating an overall under-recognition of symptoms of delirium. Only the age of the residents (≥ 85 yrs) was associated with undetected delirium (OR: 4.1; 90% CI: [1.5–11.0]).</p> <p>Conclusion</p> <p>Detection of delirium is a major issue for nurses that clearly needs to be addressed. Strategies to improve recognition of delirium could result in a reduction of adverse outcomes for this very vulnerable population.</p

Hydrodilatation, corticosteroids and adhesive capsulitis: A randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Hydrodilatation of the glenohumeral joint is by several authors reported to improve shoulder pain and range of motion for patients with adhesive capsulitis. Procedures described often involve the injection of corticosteroids, to which the reported treatment effects may be attributed. Any important contribution arising from the hydrodilatation procedure itself remains to be demonstrated.</p> <p>Methods</p> <p>In this randomized trial, a hydrodilatation procedure including corticosteroids was compared with the injection of corticosteroids without dilatation. Patients were given three injections with two-week intervals, and all injections were given under fluoroscopic guidance. Outcome measures were the Shoulder Pain and Disability Index (SPADI) and measures of active and passive range of motion. Seventy-six patients were included and groups were compared six weeks after treatment. The study was designed as an open trial.</p> <p>Results</p> <p>The groups showed a rather similar degree of improvement from baseline. According to a multiple regression analysis, the effect of dilatation was a mean improvement of 3 points (confidence interval: -5 to 11) on the SPADI 0–100 scale. T-tests did not demonstrate any significant between-group differences in range of motion.</p> <p>Conclusion</p> <p>This study did not identify any important treatment effects resulting from three hydrodilatations that included steroid compared with three steroid injections alone.</p> <p>Trial registration</p> <p>The study is registered in Current Controlled Trials with the registration number ISRCTN90567697.</p

Genome-Wide Screen of Three Herpesviruses for Protein Subcellular Localization and Alteration of PML Nuclear Bodies

Herpesviruses are large, ubiquitous DNA viruses with complex host interactions, yet many of the proteins encoded by these viruses have not been functionally characterized. As a first step in functional characterization, we determined the subcellular localization of 234 epitope-tagged proteins from herpes simplex virus, cytomegalovirus, and Epstein–Barr virus. Twenty-four of the 93 proteins with nuclear localization formed subnuclear structures. Twelve of these localized to the nucleolus, and five at least partially localized with promyelocytic leukemia (PML) bodies, which are known to suppress viral lytic infection. In addition, two proteins disrupted Cajal bodies, and 19 of the nuclear proteins significantly decreased the number of PML bodies per cell, including six that were shown to be SUMO-modified. These results have provided the first functional insights into over 120 previously unstudied proteins and suggest that herpesviruses employ multiple strategies for manipulating nuclear bodies that control key cellular processes

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised