The association between prevalence of peritoneal dialysis vs hemodialysis and patients' distance to dialysis-providing facilities

Background: Accessibility to dialysis facilities plays a central role when deciding on a patient's long-term dialysis modality. Studies investigating the effect of distance to nearest dialysis-providing unit on modality choice have yielded conflicting results. We set out to investigate the association between patients' dialysis modality and both the driving and straight-line distances to the closest HD- and PD-providing units. Methods: All end stage kidney disease patients who initiated in-center HD and PD in 2017, 18-90 years old, and on dialysis for ≥30 days were included. Patients in residence zip codes in non-conterminous United States or lived >90 miles from the nearest HD-providing unit were excluded. Results: 102,247 patients in the United States initiated in-center HD and PD in 2017. Compared to HD patients, PD patients had longer driving distances to their nearest PD unit (4.4 vs 3.4 miles; p <0.001). Patients who lived >30 miles from the nearest HD unit were more likely to be on PD if the nearest PD unit was a distance equal to/less than the HD unit. PD utilization increased with increasing distance from patients' homes to the nearest HD unit. No change in this association was found regardless of if the PD unit was farther/closer than the nearest HD unit. This association was not seen with straight line distance analysis. Conclusions: With increasing distances from the nearest dialysis providing units (HD or PD), PD utilization increased. Using driving distance rather than straight line distance affects data analysis and outcomes. Increasing the number of PD units may have a limited impact on increasing PD utilization.

Locomotion postural variability and coordination in boys with overweight

The purpose of this study was to examine the variability and coordination of postural adaptations in normal weight children and those with overweight in running and hopping. Fifty-six boys between 7 and 10 years were classified into groups as overweight ( n = 33) or normal-weight ( n = 23). They performed two trials of running and hopping over a 20-m straight line distance. Accelerometers were attached on the trunk and head for collecting body movements in different directions from 15 strides. Postural variability and coordination were calculated by multiscale entropy and cross approximate entropy for the running and hopping trials, separately. Findings highlight overweight boys had significantly higher trunk-head coordination in mediolateral direction than normal-weight boys (0.72 vs. 0.68). The hopping movement pattern had highest variability (9.88 vs. 8.77) and trunk–head coordination (0.61 vs. 0.67) than running. Excess body mass demands additional postural adaptations to compensate for reducing the risk of losing balance laterally in boys with overweight.

Effects of Apigenin and Astragalus Polysaccharide on the Cryopreservation of Bull Semen

The purpose of this study was to determine the effects of apigenin and astragalus polysaccharides on the cryopreservation of bovine semen. Apigenin, astragalus polysaccharides, or their combination were added to a frozen diluent of bovine semen. Afterwards, Computer Assisted Semen Analysis (CASA), membrane functionality, acrosome integrity, mitochondrial integrity, CAT, SOD, GSH-Px, MDA, and ROS detection were conducted. The results showed that adding 0.2 mmol/L AP or 0.5 mg/mL APS could improve the quality of frozen sperm. Compared to 0.2 mmol/L AP alone, the combination of 0.2 mmol/L AP and 0.3 mg/mL APS significantly increased the total motility (TM), average path distance (DAP), straight line distance (DSL), average path velocity (VAP), curvilinear velocity (VCL), wobble (WOB), and sperm CAT and SOD levels (p < 0.05), while reducing the ROS and MDA levels (p < 0.05). These results indicated that the addition of 0.2 mmol/L AP or 0.5 mg/mL APS alone has a protective effect on the freezing of bovine semen. Compared to the addition of 0.2 mmol/L AP, a combination of 0.2 mmol/L AP and 0.3 mg/mL APS could further improve the quality of frozen semen.

Geographical accessibility of medicines: a systematic literature review of pharmacy mapping

Background Measuring access to medicines has often been limited to assessing availability and affordability, while little is known regarding other dimensions of access including geographical accessibility. Our study aims to provide a systematic review of literature on the accessibility of medicines by studying the geographical distribution of pharmacies using Spatial Analytical methods. Methods As systematic review of scientific peer-reviewed literature between 2000 and 2018 was carried out using PubMed, Web of Science, Google Scholar, Google and the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA). Data regarding pharmacy density, distance to pharmacies in relation of pharmacy to sociodemographic factors and pharmacy characteristics were extracted from studies that meet the inclusion criteria. Findings Twenty papers fulfilled our inclusion criteria, of which only three were from middle income countries and rest from high-income economies. Pharmacy density per population was reported in 15 studies. Although geographical information was utilized in all studies, only 14 studies reported distance to pharmacies represented as Euclidean (straight line) distance. Disparities in accessibility was reported according to population income and rural or urban location. Seven studies described additional pharmacy characteristics including opening hours, presence of a pharmacist and delivery services. Conclusions Geographical accessibility is a key dimension of access to medicines. Pharmacy density per population is a relevant indicator to assess geographical accessibility which should be complemented by an equity analysis using socio-demographic information and population perception of accessibility.

Urban-Rural Differences in Geodetic Distance Between Home and the Nearest Pharmacy Among Older Pennsylvania Adults

Aim: We examined differences in geodetic or straight line distance between home and the nearest community pharmacy among rural and urban older adults in Pennsylvania. Method: The addresses of 241,398 older adults (≥65 years) and 2,880 community pharmacies enrolled in Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) program in 2018 were geocoded. We identified pharmacies in the same or adjacent counties for each enrollee and measured the geodetic distance between home and those pharmacies. The pharmacy with the shortest distance from home was identified as the nearest pharmacy for each enrollee. Enrollees’ home addresses were categorized as urban or rural at the county level, based on the Center for Rural Pennsylvania’s definitions. T-tests and chi-squared tests were used for analyses. Results: Overall, 37% were rural older adults and the mean distance between home and the nearest pharmacy was 1.60 ± 2.21 miles. The mean distance between home and the nearest pharmacy was significantly greater in rural compared to urban older adults (2.78 ± 2.93 versus 0.91 ± 1.19; p&lt;.0001). A higher proportion of rural older adults resided &gt;5 miles away from the nearest pharmacy compared to urban older adults (19.19% versus 1.80%; p&lt;.0001). Moreover, 2.96% of rural older adults resided &gt;10 miles away from the nearest pharmacy compared to 0.08% of urban older adults (p&lt;.0001). Conclusion: Older patients in rural counties need to travel longer distances for pharmacy access than in urban counties. Efforts to provide convenient access to medications and pharmacy services for rural older patients are necessary.

Vertical distance from navel as a risk factor for bowel obstruction associated with feeding jejunostomy after esophagectomy: a retrospective cohort study

Background Placement of feeding jejunostomy (PFJ) during esophagectomy is an effective method to maintain adequate nutrition, but is associated with serious complications such as bowel obstruction and jejunal torsion. The purpose of the current study was to analyze the incidence, clinical features, and risk factors of bowel obstruction associated with feeding jejunostomy (BOFJ) after PFJ. Methods This was a retrospective cohort study of 70 patients who underwent esophagectomy with three-field lymph node dissection for esophageal cancer and treated with PFJ between March 2013 and December 2019 in our hospital. Abdominal dissection was performed under hand-assisted laparoscopic surgery (HALS) from March 2013 to March 2015, and was changed to complete laparoscopic surgery in April 2015. We compared patients with and without BOFJ, and the incidence of BOFJ was evaluated. The primary endpoint was incidence of BOFJ after PFJ. Results Six patients (8.5%) were diagnosed with BOFJ, all of whom were symptomatic and in the HALS group. In addition, 3 cases displayed histories of recurrent BOFJ (3, 3, and 5 times). Laparotomy was performed in all cases. Subgroup analysis of the HALS group showed a significant difference only in straight-line distance between the jejunostomy and navel as a significant pre- and perioperative factor (117 mm [101–130 mm] vs. 89 mm [51–150 mm], p < 0.001). Furthermore, dividing straight-line distance between the jejunostomy and navel into VD and HD, only VD differed significantly (107 mm [93–120 mm] vs. 79 mm [28–135 mm], p = 0.010), not HD (48 mm [40–59 mm] vs. 46 mm [22–60 mm], p = 0.199). Conclusions VD between the jejunostomy and navel was associated with BOFJ after PFJ with HALS esophagectomy. PFJ < 9 cm above the navel during HALS esophagectomy might effectively prevent BOFJ.

2D Photogrammetry as a Forwarder Load Measurement Technique

Research Highlights: In this study, we present the use of time-lapse photos as a way to estimate the height of the load on the forwarders. This approach, using nonprofessional outdoor cameras, is a cheap and time-effective solution for continuous load height measurements, and it offers at least the same accuracy as a gauge measurement. This method represents another approach to the automation of time studies in forestry. Background and Objectives: Time studies require information about the load on the forwarders. Until now, this information was obtained either by using a gauge measure, sampling of the load, or averaging the load from large area datasets. More accurate methods like laser scanning are costly and fragile. During time study preparations, we suggested a robust system of measuring the load height and tested it against the commonly used gauge measuring technique. Materials and Methods: Two cameras took pictures of the load; these photos were processed for camera lens distortion and rectified into the cartesian coordinate system, and the height of the load was calculated. These values were then tested against gauge measured values using paired t-test. Results: Straight line distance calculated from the images and the gauge-measured distance did not show a significant difference (p-value 0.9354). Calculated vertical distance was, however, significantly different from the calculated straight-line distance (p-value of 0.0015), suggesting possible bias of the gauge measured distance. The root mean square error (RMSE) of the rectification process was, on average, 0.42 cm. Conclusions: The proposed method was verified to correspond with the gauge measure method; however, our research raised the question of the gauge method reliability, as the taken measurements are not perfectly vertical, and for the correct load estimation, the vertical distance is needed. We, therefore, conclude that for this photogrammetry method, the vertical, rather than straight-line, distance should be used. The presented solution can be used for long-term data collection without interrupting the whole forwarding process for taking the load measurement. The longer data processing in office enables researchers to spend less time in the field taking hand measurements.

Improving cognitive mapping by training for people with a poor sense of direction

The skill of spatial learning and orientation is fundamental in humans and differs widely among individuals. Despite its importance, however, the malleability of this skill through practice has scarcely been studied empirically, in contrast to psychometric spatial ability. Thus, this article examines the possibility of improving the accuracy of configurational understanding of the environment by training. A total of 40 adults with a poor sense of direction participated in the experiment; and were randomly assigned to either a condition in which they received feedback only or a condition in which they additionally practiced allocentric spatial updating. Participants walked one route in each session, once a week for 6 weeks, and conducted spatial tasks designed to assess their knowledge of the route. A total of 20 people with an average sense of direction also participated as a comparison group. Results showed that training in allocentric spatial updating improved the accuracy of direction estimates, although the size of the effect was limited: the improvement was not large enough to equate the performance in the groups with a poor versus average sense of direction. The two groups, however, did not differ in spatial skill in mental rotation or path integration. Feedback was effective for improving accuracy in straight-line distance estimates and sketch maps: repeated trials with feedback led to improved accuracy by the sixth session to a level comparable to the group with an average sense of direction. The results show that flexible translation between viewer-centered and environment-centered representations is difficult and not readily trainable, and provide insights into the nature of individual differences in large-scale environmental cognition.

The effect of clay tortuosity on contaminant plume persistence

&lt;p&gt;The presence of contaminated aquitards has been recognized as one of the main obstacles that hamper the successful aquifer restoration and the forward and back diffusion processes were known as the primary mechanism of solute exchange between the aquifer-aquitard system. In this study, a series of 2-D flow chamber experiments were conducted using 1 g/L of bromide solution as a non-reactive tracer to evaluate back diffusion phenomenon and plume tailing behavior based on different clay types (kaolinite, montmorillonite, and bentonite). In order to determine appropriate values for clay tortuosity, simulated effluent concentrations using 1-D analytical solutions were compared to the measured effluent concentrations. The best fits were found with for bentonite, for kaolinite, and The bentonite tortuosity value close to 1 indicates that the solute flowpath is similar to the aquitard straight-line distance under the saturated condition. Simulation results using the calculated tortuosity showed that bromide effluent concentration due to back diffusion from the montmorillonite layer decreased to 3 orders of magnitude below the initial concentration after 60 days of back diffusion. For bentonite, calculated effluent concentrations decreased to 3 orders of magnitude below the initial concentration after 230 days of back diffusion. These results suggest that the aquitard with higher tortuosity has more capability to sustain long-term plume persistence for non-reactive contaminants and more potential risks as secondary contaminant sources.&lt;/p&gt;