Increasing Equitable Access to Individuals with Disabilities: Participation in Electronic Public Administration Research

Individuals with disabilities (both physical and cognitive) constitute 15% of the global population and 25% of U.S. citizens. However, public administration has not given explicit thought to how current research methods and other data collection processes or tools might exclude individuals with disabilities. This lack of attention to research methods and instruments might impose barriers and limit access to participation for individuals with disabilities who would otherwise meet the requirements for participation within the research design. This omission undermines social equity, a critical pillar of public administration, by systematically excluding individuals with disabilities from the research process. Equitable research ensures that scholars are not excluding participants from the research while obtaining insights from the ‘relevant population.’ Current exclusionary practices raise several questions that are addressed in this essay including: (1) What are the implications of equitable access in electronic research? (2) What are the barriers of access for individuals with disabilities who want to participate in research, like surveys conducted through an electronic delivery system? and (3) What would an equitable data collection and research design look like?

INNV-32. ACCESS TO SPECIALTY RADIATION CARE FOR PATIENTS WITH RESECTABLE BRAIN TUMORS

INTRODUCTION Many patients with brain tumors face challenges with access to care. For rural patients, prolonged travel times may limit access to appropriate radiotherapy. Radiation centers (RCs) offering specialized brain radiotherapy, e.g., stereotactic radiosurgery (SRS), are geographically limited. Brain brachytherapy at the time of resection offers an option for such patients, but technical challenges have limited the adoption. To address the limitations of traditional brachytherapy, a device with Cs-131 seeds embedded in a bioresorbable collagen tile (GammaTile (GT), GT Medical Technologies, Tempe, AZ) was developed. The device is FDA-cleared for permanent implantation at the time of resection for all recurrent intracranial tumors and newly diagnosed malignant intracranial neoplasms. To investigate if wider availability of this treatment could possibly lower the geographic barrier to access to care, we mapped the US population against existing RCs with brain tumor expertise and neurosurgery centers (NSCs) performing craniotomies. METHODS We analyzed 2018 CMS claims data using CPT codes for single- and multi-fraction SRS to identify RCs with brain tumor treatment expertise and mapped these against the population. Using similar methodology, using CPT codes for craniotomies, we identified NSCs, as any facility performing craniotomies is potentially eligible to implant the device. RESULTS 135 RCs used CPT codes for SRS. 193-, 119-, 82-, and 52-million Americans lived >30-, >60-, >90-, and >120-minutes from one of these centers, respectively. 530 NSCs preform craniotomies, including ≥ 1 in every state, a 4-fold increase over the number of RCs offering SRS. CONCLUSIONS For many patients, substantial travel distances limit access to RCs with brain tumor treatment expertise. In contrast, the 530 craniotomy-performing NSCs have far greater geographic dispersion. The option of undergoing brain radiation with GT implantation at the time of brain tumor craniotomy brings treatment closer to millions, ensures compliance, and reduces additional travel for follow-up radiation treatment.

Threshold space for prevention and control of COVID-19 exposed environment

Dwelling as an alternative to cure and isolate confirmed positive or asymptomatic people of COVID-19 becomes an essential place. However, it is necessary to ensure no physical contact between dwelling users since COVID-19 can be transmitted through droplets. Preventing and controlling the transmission is achieved by inserting transitional space between users, activities, or programs. The idea of transitional space is determined from Rumoh Aceh, an adaptive vernacular design that provides a boundary between public and private zones to limit access to strangers. This paper aims to translate space configurations of Rumoh Aceh as local wisdom to break the chain of COVID-19 transmission by making transitional space, a separation between confirmed positive or asymptomatic and healthy people. The data is obtained from the observation of three Rumoh Aceh in Banda Aceh and Aceh Besar. The space configurations are translated into five types of threshold space, promoting social distancing between users, providing cleaning space for personal hygiene, giving atmosphere for self-isolation, having natural ventilation features, and daylight exposure. Then, these types are explored and adapted in a contemporary dwelling design. As a final translation and exploration, this paper provides strategies and design recommendations for a threshold space in a contemporary dwelling design. The strategies and recommendations are explored and adapted in a 60 square meter house plan.

The IMPLEMENTATION OF SYSTEM DOOR ACCES USING FACE RECOGNITION AND FINGER PRINT FOR MUNITIONS WAREHOUSE WITH A BASE HAAR CASSCADE

Technology in the military world has been growing with the existence of technological innovations that are used to secure munitions warehouses. This is done to reduce the negligence of the munitions warehouse guard personnel if they lose the key from the munitions warehouse it can be monitored in real-time to find out who is around the munitions warehouse door. Thus, face recognition and fingerprint technology were created as a system for securing munitions warehouses, as well as the function is to be a CCTV. So, they can be monitored in real-time. This research method uses an experimental method to obtain quantitative data to prove the hypothesis data that use the Haar Cascade. The results of this study indicate that this security system has a very important role to limit access to and from the munitions warehouse and reduce the occurrence of theft or misuse of munitions. In the tests carried out, the minimum detection distance was 20 cm and the maximum distance that was able to detect was 110 cm. this is influenced by the focus of the camera and testing of the intensity of light in the morning, afternoon, evening, and night can be detected except detection at night without light and must use a fingerprint.

A review exploring the overarching burden of Zika virus with emphasis on epidemiological case studies from Brazil

This paper explores the main factors for mosquito-borne transmission of the Zika virus by focusing on environmental, anthropogenic, and social risks. A literature review was conducted bringing together related information from this genre of research from peer-reviewed publications. It was observed that environmental conditions, especially precipitation, humidity, and temperature, played a role in the transmission. Furthermore, anthropogenic factors including sanitation, urbanization, and environmental pollution promote the transmission by affecting the mosquito density. In addition, socioeconomic factors such as poverty as well as social inequality and low-quality housing have also an impact since these are social factors that limit access to certain facilities or infrastructure which, in turn, promote transmission when absent (e.g., piped water and screened windows). Finally, the paper presents short-, mid-, and long-term preventative solutions together with future perspectives. This is the first review exploring the effects of anthropogenic aspects on Zika transmission with a special emphasis in Brazil.

Tramadol Poisoning: A Systematic Review of Studies in Iran

Background: According to statistics, tramadol use is extremely prevalent in Iran. Besides, tramadol overdose is mostly observed in young individuals. Given the significance of this issue and the increasing prevalence of tramadol use in Iran, this study aimed to systematically review tramadol poisoning in Iran. Methods: In this review, a search was conducted in Persian databases of IranMedex, SID, Medlib, Magiran, as well as Google Scholar using the keywords of “poisoning and tramadol” without a time limitation. Results: Some of the main issues related to tramadol poisoning were as follows: the majority of cases consumed tramadol to commit suicide; most tramadol consumers were aged below 30 years; the majority of patients with tramadol poisoning were single and male; tramadol was mostly used orally; in most studies, patients were hospitalized for >24 hours; the majority of patients concomitantly took other medications with tramadol; in most studies, patients had a history of tramadol use; most studies reported a relationship between tramadol dose and seizures, and the most common cause of hospital referral was decreased consciousness level. Conclusion: Tramadol misuse and poisoning could lead to seizures and often death. Besides, most cases with tramadol poisoning were aged below 30 and consumed tramadol to commit suicide. Thus, it is crucial to improve the youth’s awareness about tramadol use, develop methods to prevent suicides, and limit access to this drug, especially in young adults.

Does the socio-demographic profile of patients limit access to bariatric surgery?

Purpose Surgery remains the only treatment allowing for a significant and sustainable weight loss in case of severe obesity. Patients undergo a specific multidisciplinary preparation and selection before the operation. This study aims to correlate the psychosocial profile with the likelihood of undergoing bariatric surgery in patients enrolled in the preparation program of a Swiss reference center. Methods All patients referred to an obesity center between January 1, 2016, and June 30, 2017, seeking a first bariatric procedure were included. Socio-demographic data, BMI, preoperative psychological and dietary evaluations were collected. Usually, the preoperative process lasts 1 year. Patients who left the preparation or who had not undergone surgery after more than 2 years of follow-up were considered withdrawers. Surgery completion predictors were reviewed with bivariate analysis and socio-demographic clusters established using the K-means method. Results Out of a total of 221 patients, 99 (45%) patients had not undergone bariatric surgery 2 years after their first consultation. The patients were divided into four distinct socio-demographic clusters, among which a particularly deprived one. Criteria such as unfavorable psychological (p < 0.001) and dietary (p < 0.001) evaluations, and male gender (p < 0.05) were significantly associated with non-operation, unlike socio-demographic indicators and clusters (p > 0.1). Conclusion Almost half of the patients starting a bariatric program are not operated on, which is related to an unfavorable psychological or dietary evaluation and to the male gender. This study also demonstrates that a significant share of patients combines several factors of social deprivation, without influencing the likelihood of surgery completion. Level of evidence Level V: Descriptive study.

A clinical update on managed care implications for Australian psychiatric practice

Objective: To provide a clinical update on private health insurance in Australia and outline developments in US-style managed care that are likely to affect psychiatric and other specialist healthcare. We explain aspects of the US health system, which has resulted in a powerful and profitable private health insurance sector, and one of the most expensive and inefficient health systems in the world, with limited patient choice in psychiatric treatment. Conclusions: Australian psychiatrists should be aware of changes to private health insurance that emphasise aspects of managed care such as selective contracting, cost-cutting or capitation of services. These approaches may limit access to private hospital care and diminish the autonomy of patients and practitioners in choosing the most appropriate treatment. Australian patients, carers and practitioners need to be informed about the potential impact of private managed care on patient-centred evidence-based treatment.