AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patients

Background Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount. Combining these two types of measure into a single index provides a measure of geographic (or spatial) coverage, which is an important measure for assessing the degree of accessibility of a health care network. Results This paper describes the latest version of AccessMod, an extension to the Geographical Information System ArcView 3.×, and provides an example of application of this tool. AccessMod 3 allows one to compute geographic coverage to health care using terrain information and population distribution. Four major types of analysis are available in AccessMod: (1) modeling the coverage of catchment areas linked to an existing health facility network based on travel time, to provide a measure of physical accessibility to health care; (2) modeling geographic coverage according to the availability of services; (3) projecting the coverage of a scaling-up of an existing network; (4) providing information for cost effectiveness analysis when little information about the existing network is available. In addition to integrating travelling time, population distribution and the population coverage capacity specific to each health facility in the network, AccessMod can incorporate the influence of landscape components (e.g. topography, river and road networks, vegetation) that impact travelling time to and from facilities. Topographical constraints can be taken into account through an anisotropic analysis that considers the direction of movement. We provide an example of the application of AccessMod in the southern part of Malawi that shows the influences of the landscape constraints and of the modes of transportation on geographic coverage. Conclusion By incorporating the demand (population) and the supply (capacities of heath care centers), AccessMod provides a unifying tool to efficiently assess the geographic coverage of a network of health care facilities. This tool should be of particular interest to developing countries that have a relatively good geographic information on population distribution, terrain, and health facility locations.

Multiple independent genetic factors at NOS1AP modulate the QT interval in a multi-ethnic population.

Extremes of electrocardiographic QT interval are associated with increased risk for sudden cardiac death (SCD); thus, identification and characterization of genetic variants that modulate QT interval may elucidate the underlying etiology of SCD. Previous studies have revealed an association between a common genetic variant in NOS1AP and QT interval in populations of European ancestry, but this finding has not been extended to other ethnic populations. We sought to characterize the effects of NOS1AP genetic variants on QT interval in the multi-ethnic population-based Dallas Heart Study (DHS, n = 3,072). The SNP most strongly associated with QT interval in previous samples of European ancestry, rs16847548, was the most strongly associated in White (P = 0.005) and Black (P = 3.6 x 10(-5)) participants, with the same direction of effect in Hispanics (P = 0.17), and further showed a significant SNP x sex-interaction (P = 0.03). A second SNP, rs16856785, uncorrelated with rs16847548, was also associated with QT interval in Blacks (P = 0.01), with qualitatively similar results in Whites and Hispanics. In a previously genotyped cohort of 14,107 White individuals drawn from the combined Atherosclerotic Risk in Communities (ARIC) and Cardiovascular Health Study (CHS) cohorts, we validated both the second locus at rs16856785 (P = 7.63 x 10(-8)), as well as the sex-interaction with rs16847548 (P = 8.68 x 10(-6)). These data extend the association of genetic variants in NOS1AP with QT interval to a Black population, with similar trends, though not statistically significant at P<0.05, in Hispanics. In addition, we identify a strong sex-interaction and the presence of a second independent site within NOS1AP associated with the QT interval. These results highlight the consistent and complex role of NOS1AP genetic variants in modulating QT interval.

Prognostic significance of foveal capillary drop-out and previous panretinal photocoagulation for diabetic macular oedema treated with ranibizumab

AIMS To investigate the prognostic significance of macular capillary drop-out and previous panretinal laser photocoagulation in diabetic macular oedema treated with intravitreal ranibizumab. METHODS Retrospective observational case series. Treatment-naive patients with diabetic macular oedema that had been treated with intravitreal ranibizumab as per the RESTORE study protocol for at least 12 months were included. Some patients (n=15) had previous panretinal laser photocoagulation. Best-corrected visual acuity and central retina thickness were recorded monthly. The foveal avascular zone and the perifoveal capillaries were quantitatively and qualitatively assessed on fluorescein angiography on two occasions during the observational period. RESULTS From the 46 eyes (46 patients) in this study, 13 (28%) had evidence of perifoveal capillary drop-out. Central retinal thickness was significantly thinner at baseline (p=0.02) and throughout the study period in these eyes compared with those with normal perifoveal capillaries. Both groups responded with a significant gain of best-corrected visual acuity to ranibizumab treatment (7.6±3.3 and 6.3±1.3 ETDRS letters, respectively). Eyes with previous panretinal laser photocoagulation displayed a comparable final outcome regarding function and morphology, requiring a similar intensity of intravitreal injections. CONCLUSIONS Perifoveal capillary drop-out did not limit the gain of visual acuity from intravitreal ranibizumab treatment. The reduction of central retina thickness was similar to that seen in eyes with normal perifoveal capillaries. Central retinal thickness in eyes with perifoveal capillary drop-out was generally reduced. However, this did not affect their benefit from treatment. Ranibizumab did not increase the amount of perifoveal capillary loss.

A COMPARISON OF COUNTY HOSPITAL UTILIZATION BEFORE AND AFTER INTERVENTION BY THE HOSPITAL'S ALCOHOLISM SERVICES PROGRAM

This study examines the reduction in hospital utilization of 393 public hospital patients who were referred to the hospital's alcoholism screening program for intervention. The 393 patients were the total patient population of the alcoholism screening program for the period of September through December, 1982. Medical records of these patients were investigated to assess the total number of hospital days six months before and six months after intervention. The findings support the hypothesis of decreased utilization. The total number of hospital days for 393 patients before intervention of the alcoholism program was 3,458, with a mean length of stay of 8.80 days. The total number of hospital days after intervention was 458 days, with a mean length of stay of 6.50 days. The average individual difference (decrease) was 7.63 days for one year. From a total of 393 patients counseled by the alcoholism program, 106 (27%) went to treatment for their alcoholism. Other aims were to examine the referral sources (physicians, nurses, social workers and the MAST); study the impact of familial history of alcoholism on referrals, and explore the MAST scores of patients successfully referred. Implications of the study are that it would benefit the public hospital, with their disproportionate numbers of alcoholics, to intervene in the behavioral patterns of alcoholism. Such intervention would be a factor in reducing the overall hospitalization of the alcoholic. ^

Bullied status and physical activity in Texas youths

Data from the 2009–2011 School Physical Activity and Nutrition (SPAN) project were analyzed to examine the association between bullied status at school during the past six months and engaging in five or more days of physical activity during the past seven days in a population of 8th and 11th grade Texas youths after stratifying by gender. As a secondary aim, this study also examined the association between weight status and the prevalence of bullied status at school. The final sample size for this study, after excluding missing data, consisted of 6,246 8th and 11th grade youths (girls, n= 3,237; boys, n=3,009) representing a total of 518,838 youths from 8th and 11th grade. Results from the multiple logistic regression adjusting for weight status, grade, and ethnicity, indicate that girls with a bullied status of at least two or three times per month had significantly lower odds of engaging in five or more days of physical activity during the past seven days than girls who were never bullied at school (ORadj=0.62; 95% CI, 0.40, 0.96). Conversely, girls who reported a bullied status of at least once per week were significantly more likely to engage in five or more days of physical activity during the past seven days compared to girls who were never bullied at school (ORadj=3.44; 95% CI, 1.56, 7.63). No significant associations between bullied status and engaging in five or more days of physical activity during the past seven days were found for boys. Bullied status differed significantly across weight status for 8th grade girls (χ2(6)=63.7, p<.05) and 11th grade boys (χ2(6) =94.93, p<.05), with overweight and obese youths reporting a higher prevalence of being bullied once or twice, at least two or three times per month, and at least once per week than their normal weight peers. Our finding that girls with bullied status of at least once per week were more likely to engage in five or more days of physical activity than girls who were never bullied warrants future qualitative research to identify potential explanations for such results. Future research on relational and weight-based bullying is also needed and may help explain the inconsistent findings between bullied status and engaging in physical activity in girls.^

Caries de la infancia temprana, demanda de atención odontológica y percepción parental de salud bucal en pre-escolares de riesgo social del Gran Mendoza

La caries de la infancia temprana es un problema de salud pública que afecta con mayor agresividad a preescolares en riesgo social. El objetivo del presente trabajo fue establecer las asociaciones existentes entre estado dental, demanda de atención odontológica, percepción de salud bucal y condición socio-económica en niños preescolares del Gran Mendoza. Material y método: la población estuvo constituida por escolares en una muestra intencionada de 155 niños de nivel inicial residentes en la provincia de Mendoza, pertenecientes al ámbito escolar urbano- marginal. Se registraron los siguientes índices: ceod, CPOD, ceos, CPOS, y sus componentes discriminados, ICDAS II, íNTC (Bordoni, 1998) e índice de placa (Silness y Löe, 1967). Fue aplicado un cuestionario de percepción parental de salud bucal (ECOHIS) y se realizaron encuestas estructuradas sobre tipología de la demanda de atención odontológica y de condiciones socioeconómicas (NBI). Fue determinada la distribución de frecuencias y los intervalos de confianza para cada variable, las medidas de tendencia central y dispersión y se realizaron comparaciones entre grupos mediante la prueba de chi cuadrado con p=0.05. Resultados: 85.8% de la muestra presentó experiencia de caries. Para cada indicador se registraron los siguientes valores: ceod+CPOD= 5.716 +/- 4.08; cd+CD =5,39+3.79; ed+PD= 0.25+- 0.72; y od+OD= 0.08+-0.34; ceos+CPOS=8.89+-8.39; cs+CS=7.63+-6.25; es+PS= 1.23+-3.62; y os+OS= 0.12+0.46; IP= 1.04+-0.48; y INTC=5.65+-3.19. No se observaron diferencias significativas al agrupar los niños por sexo. Al analizar la demanda de atención bucal se observó que el 54,9% efectuó una consulta odontológica, 25% en el último año y 74% en el subsistema de salud pública. El análisis del cuestionario ECOHIS reveló que obtuvo el máximo porcentaje de respuestas cuando se ordenó según la categoría nunca. El único ítem que se relacionó con el estado dental en forma estadísticamente significativa fue el dolor. Conclusiones: Se observa alta prevalencia de caries dental sin que la demanda de atención odontológica haya producido impacto positivo sobre el estado dentario ni sobre la percepción de los padres respecto de la salud bucal.

Velocities and elastic moduli of basalts from Pacific DSDP sites

Compressional (Vp) and shear (Vs) wave velocities have been measured to 10 kb in 32 cores of basalt from 14 Pacific sites of the Deep Sea Drilling Project. Both Vp and V s show wide ranges (3.70 to 6.38 km/sec for Vp and 1.77 to 3.40 km/sec for V s at 0.5 kb) which are linearly related to density and sea floor age, confirming earlier findings by Christensen and Salisbury of decreasing velocity with progressive submarine weathering based on studies of basalts from five sites in the Atlantic. Combined Pacific and Atlantic data give rates of decreasing velocity of -1.89 and -1.35 km/sec per 100 my for Vp and Vs respectively. New analyses of oceanic seismic refraction data indicate a decrease in layer 2 velocities with age similar to that observed in the laboratory, suggesting that weathering penetrates to several hundred meters in many regions and is largely responsible for the extreme range and variability of layer 2 refraction velocities.

Entrelíneas para una introspección poética : Rubén Darío y Antonio Machado en 1903

Este trabajo intenta mostrar una actitud poética común coincidente entre Antonio Machado y Rubén Darío. Dicha actitud, que consiste en defender la introspección como fórmula adecuada para la expresión poética, es perceptible en un momento determinado de la trayectoria poética individual de cada uno. Sin embargo, es interesante ver cómo se muestra en el diálogo estético que ambos establecen a través de su creación como ofrenda al otro: aquellos poemas en los que el paratexto se dedica al otro pero el texto no se adecua (no utilizan el ritmo, el tono y el léxico) a quien va dirigida la dedicatoria. Obras que son parte de uno mismo, canto a sí mismo, y, sin embargo, se ofrecen al otro. Esta ofrenda puede apreciarse, desde nuestra perspectiva, en dos poemas concretos: "El canto de los niños", y "Caracol". Dedicados del uno al otro, son analizados en coincidencia estética entre Darío y Machado en torno a la fecha de 1903.

Entrelíneas para una introspección poética : Rubén Darío y Antonio Machado en 1903

Este trabajo intenta mostrar una actitud poética común coincidente entre Antonio Machado y Rubén Darío. Dicha actitud, que consiste en defender la introspección como fórmula adecuada para la expresión poética, es perceptible en un momento determinado de la trayectoria poética individual de cada uno. Sin embargo, es interesante ver cómo se muestra en el diálogo estético que ambos establecen a través de su creación como ofrenda al otro: aquellos poemas en los que el paratexto se dedica al otro pero el texto no se adecua (no utilizan el ritmo, el tono y el léxico) a quien va dirigida la dedicatoria. Obras que son parte de uno mismo, canto a sí mismo, y, sin embargo, se ofrecen al otro. Esta ofrenda puede apreciarse, desde nuestra perspectiva, en dos poemas concretos: "El canto de los niños", y "Caracol". Dedicados del uno al otro, son analizados en coincidencia estética entre Darío y Machado en torno a la fecha de 1903.

Entrelíneas para una introspección poética : Rubén Darío y Antonio Machado en 1903

Este trabajo intenta mostrar una actitud poética común coincidente entre Antonio Machado y Rubén Darío. Dicha actitud, que consiste en defender la introspección como fórmula adecuada para la expresión poética, es perceptible en un momento determinado de la trayectoria poética individual de cada uno. Sin embargo, es interesante ver cómo se muestra en el diálogo estético que ambos establecen a través de su creación como ofrenda al otro: aquellos poemas en los que el paratexto se dedica al otro pero el texto no se adecua (no utilizan el ritmo, el tono y el léxico) a quien va dirigida la dedicatoria. Obras que son parte de uno mismo, canto a sí mismo, y, sin embargo, se ofrecen al otro. Esta ofrenda puede apreciarse, desde nuestra perspectiva, en dos poemas concretos: "El canto de los niños", y "Caracol". Dedicados del uno al otro, son analizados en coincidencia estética entre Darío y Machado en torno a la fecha de 1903.

(Table 5) Quaternary paleoproductivity of organic carbon in oceans based on DSDP cores

By analogy with the present-day ocean, primary productivity of paleoceans can be reconstructed using calculations based on content of organic carbon in sediments and their accumulation rates. Results of calculations based on published data show that primary productivity of organic carbon, mass of phosphorus involved in the process, and content of phosphorus in ocean waters were relatively stable during Cenozoic and Late Mesozoic. Prior to precipitation on the seafloor together with biogenic detritus, dissolved phosphorus could repeatedly be involved in the biogeochemical cycle. Therefore, only less than 0.1% of phosphorus is retained in bottom sediments. Bulk phosphorus accumulation rate in ocean sediments is partly consistent with calculated primary productivity. Some epochs of phosphate accumulation also coincide with maxima of primary productivity and minima of the fossilization coefficient of organic carbon. The latter fact can testify to episodes of acceleration of organic matter mineralization and release of phosphorus from sediments leading to increase in the phosphorus reserve in paleoceans and phosphate accumulation in some places.

Biostratigraphy, magnetostratigraphy, granulometry, isotopes and clay mineral composition of ODP Site 188-1165

During Ocean Drilling Program Leg 188 to Prydz Bay, East Antarctica, several of the shipboard scientists formed the High-Resolution Integrated Stratigraphy Committee (HiRISC). The committee was established in order to furnish an integrated data set from the Pliocene portion of Site 1165 as a contribution to the ongoing debate about Pliocene climate and climate evolution in Antarctica. The proxies determined in our various laboratories were the following: magnetostratigraphy and magnetic properties, grain-size distributions (granulometry), near-ultraviolet, visible, and near-infrared spectrophotometry, calcium carbonate content, characteristics of foraminifer, diatom, and radiolarian content, clay mineral composition, and stable isotopes. In addition to the HiRISC samples, other data sets contained in this report are subsets of much larger data sets. We included these subsets in order to provide the reader with a convenient integrated data set of Pliocene-Pleistocene strata from the East Antarctic continental margin. The data are presented in the form of 14 graphs (in addition to the site map). Text and figure captions guide the reader to the original data sets. Some preliminary interpretations are given at the end of the manuscript.