Access Planning Research Articles

Optimizing Colon Identification by Window Setting Modulation on Noncontrast Computed Tomography Prior to Percutaneous Nephrolithotomy.

Background: Preoperative identification of the bowel on imaging is essential in planning renal access during percutaneous nephrolithotomy (PCNL) and avoiding colonic injury. We aimed this study to assess which noncontrast computed tomography (NCCT) window setting provides the optimal colonic identification for PCNL preoperative planning. Methods: Ten urologic surgeons (four seniors, six residents) reviewed 22 images of NCCT scans in both abdomen and lung window settings in a randomized blinded order. Colonic area delineation in each image was performed using a dedicated, commercially available area calculator software. A comparison of the marked colonic area between the abdomen and lung window settings was performed. Results: Overall, the mean marked colonic area was greater in the lung window compared with the abdomen window (8.82 cm2 vs 7.4 cm2, respectively, p < 0.001). Switching the CT window from abdomen to lung increased the identified colonic area in 50 cases (50%). Intraclass correlation showed good agreement between the senior readers and among all readers (0.92 and 0.87, respectively). Similar measurements of the colonic area in both abdomen and lung windows were observed in 26/44 (60%) of the seniors cases and in 7/66 (10%) of the resident cases (p = 0.002). Conclusion: Lung window solely or in combination with abdomen window appears to provide the most accurate colonic identification for preoperative planning of PCNL access and potentially reduce the risk of colonic injury. This pattern is more evident among young urologists, and we propose to introduce it as a standard sequence in PCNL preplanning.

Family Planning Practices, Knowledge, Decision Making, and Factors Associated with Unplanned Pregnancies among Women Working in A Selected Garment Industry in Urban Bengaluru, India

Background: According to UN population estimates, India has surpassed China as the world’s most populated nation, marking the biggest upheaval in global demography since records have been kept. Providing universal family planning services is an important strategy to reduce maternal morbidity and to control population growth. Even though the country has multiple programs addressing family planning issues, they are missing out on working women. Thus, this study aims to estimate the prevalence of unmet needs of family planning and determinants for improper access to family planning methods among women working in a selected Garment industry in Urban Bengaluru. Methodology: A community based cross-sectional study was conducted in a selected garment factory for a period of two months. Women workers in Reproductive age group (18-49 years) and who gave voluntary consent to participate in the study were taken up. Total sample of 454 women were included. The data was collected using a semi-structured and validated questionnaire. Collected data was entered in Microsoft Excel and was analysed using SPSS version 16. Results: Among 454 participants, 42.3% (n=192) of them had used contraceptive method. Out of 192 women, most of them (72.9%, n=140) had chosen tubectomy as the contraceptive measure. Among 407 women, 14.3% (n=58), 13.3% (n=42), and 20.9% (n=9) of them had not planned for their 1st pregnancy, 2nd pregnancy, and 3rd pregnancy respectively. Conclusion: Less than half of them had used any form of contraceptive method. Among that half, nearly three-fourths had chosen tubectomy.

Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit.

Despite advances in neonatology, neonatal mortality from preventable causes remains high in the North and Northeast regions of Brazil. This study aimed to analyze the determinants associated with neonatal and postneonatal mortality in newborns admitted to a neonatal intensive care unit. A cohort study was carried out in a capital in the Brazilian Northeast from 2013 to 2018. The outcome studied was death. Poisson regression was performed in the multivariate analysis of variables. Four hundred and eighty newborns were eligible, and 8.1% (39 newborns) died. Among them, 34 died in the neonatal period. The determinants that remained significantly associated with neonatal and postneonatal mortality in the final adjustment model (p < 0.05) were history of abortion, perinatal asphyxia, early neonatal sepsis and umbilical venous catheterization. All causes of this outcome were preventable. The neonatal mortality rate, although it did not include twins, neonates with malformations incompatible with life and other conditions, was 3.47 deaths per thousand live births (95% CI:1.10-8.03‱), well below the national average. In this study, pregnant women from different social classes had in common a private plan for direct access to health services, which provided them with excellent care throughout pregnancy and postnatal care. These results indicate that reducing neonatal mortality is possible through public policies with strategies that promote improvements in access to health services.

Spatial modeling of the occurrences of geogenic fluoride in groundwater systems in Tanzania: Implications for the provision of safe drinking water

Inadequate data and spatial dependence in the observations during geochemical studies are among the disturbing conditions when estimating environmental factors contributing to the local variability in the pollutants of interest. Usually, spatial dependence occurs due to the researcher's imperfection on the natural scale of occurrence which affects the sampling strategy. As a consequence, observations on the study variable are significantly correlated in space. In this study, the machine learning approach was developed and used to study the environmental factors controlling the local variability in fluoride concentrations in drinking water sources of northern Tanzania within the East African Rift Valley. The approach constituted the use of geographical information systems (GIS) technology, exploratory spatial data analysis (ESDA) methods, and spatial regression modeling at a local level. The environmental variables used to study the local variation in fluoride concentration include topography, tectonic processes, water exchanges between hydrogeological layers during lateral movement, mineralization processes (EC), and water pH. The study was based on 20 local spatial regimes determined using GIS based on water sources density in the four hydrogeological environments. Specifically, the non-parametric (one-way Kruskal-Wallis sum ranks test and Multiple Comparisons Dunn Test), spatial statistics (Global Moran's I statistic), ordinary least squares (OLS) regression, and spatial lag models were used to quantify the effects of topography, tectonic processes, water exchange between hydrogeological environments and water physiochemical parameters (pH and EC) on the spatial variability of fluoride concentrations in drinking water sources at a local scale. In order of significance, the local spatial variation in fluoride concentration is influenced by the EC, topography, tectonic processes, pH, and water exchange between hydrogeological layers during water movement. The results presented in this paper are crucial for safe water access planning in naturally contaminated aquifer systems.

Is School Travel too Complex to Handle Without a Car? Assessing “Child-Friendliness” as a Pathway to Reducing Private Car use for Children’s Transport

ABSTRACT Recognising the multifaceted challenges of addressing the dominance of cars for children’s transport, this paper introduces and tests a “child-friendliness index” (CFI) to assess the performance of neighbourhoods and school catchments to enable or constrain how children travel to school. The findings demonstrate that car trips both to and from school are negatively associated with child-friendliness. However, counter-intuitively there was no significant association between distance and car use, which remained high for shorter distances (< 4 km). These findings imply school travel decisions are susceptible to many factors. We discuss the policy pathway provided by CFI for school accessibility planning.

What Is an EEAAP?: Software Accessibility Reviews and User Access

ABSTRACT Academic libraries license thousands of electronic resources and they all might not be fully accessible. Libraries need to be prepared to assist patrons with inaccessible features by putting an equally effective alternative access plan into place. Submitting accessibility reviews, either university mandated or generated from the library, helps ensure that electronic resources meet accessibility standards.

A STUDY ON ROLE OF AUTOMOBILE INDUSTRY IN INDIA AND ITS CUSTOMERS SATISFACTION

Client satisfaction is defined by ISO 9000 as the opinion of druggies regarding how well a product satisfies its requirements. A veritably particular evaluation is that of client satisfaction. The main factor propelling the expansion of the Indian machine assiduity is the rise in demand for buses and other vehicles, which is fueled by rising inflows. The development of accessible prepayment plans and customized backing options has also backed in the expansion of the bus assiduity. Encyclopedically, the automotive sector is a significant artificial and profitable force. It produces 60 million motorcars and exchanges annually, which regard for about half of the oil painting consumed worldwide. There are 4 million direct jobs in this assiduity, and numerous further circular jobs are created. Indeed if a lot of big businesses struggle with overcapacity

#1465 Enhancing vascular access planning in CKD: validating the 40% KFRE threshold in a French retrospective cohort study

Abstract Background and Aims The optimal timing for dialysis vascular access creation remains a complex clinical decision, balancing the risk of early intervention against the prospect of starting dialysis with a central venous catheter. This study sought to compare the predictive capabilities of the Kidney Failure Risk Equation (KFRE) and estimated Glomerular Filtration Rate (eGFR) in determining the appropriate timing for arteriovenous fistula (AVF) creation in patients with advanced chronic kidney disease (CKD). Method A retrospective cohort of 238 patients referred for ultrasound vascular mapping from April 2013 to June 2023 was analyzed. Data on patient characteristics, laboratory results, and clinical outcomes were collected. The 4-variable and 8-variable KFRE and eGFR were assessed for their ability to predict end-stage kidney disease (ESKD) within a 2-year period. Discrimination was evaluated using receiver operating characteristic (ROC) curves, and calibration was assessed graphically. Net benefit decision curves were utilized to compare the net benefit of the KFRE models at various threshold probabilities. Results The cohort comprised 238 patients with an average age of 65.2 years and a mean eGFR of 13.3 mL/min/m²73. During the median 10.7-month follow-up, 178 patients (74.8%) progressed to ESKD, and 21 (9.2%) died prior to reaching ESKD. At the 1-year mark, the probability of progressing to ESKD was 77.6% (95% CI, 69.9-85.3%) when a 40% threshold for the 4-variable KFRE was applied, compared to 65.8% (95% CI, 58.3-73.3%) with an eGFR threshold of 15 mL/min/m²73. Discrimination analysis demonstrated a superior predictive performance for the 8-variable KFRE at 6 months, with a C-statistic of 0.82 (95% CI: 0.76-0.88). At 1 year, both KFRE models showed strong predictive abilities, with C-statistics of 0.835 (95% CI: 0.78-0.89) for the 4-variable KFRE and 0.82 (95% CI: 0.76-0.875) for the 8-variable KFRE. Sensitivity and specificity analyses underscored the benefits of utilizing the 40% KFRE threshold for predicting ESKD over the eGFR threshold. Conclusion The study demonstrates that both the 4-variable and 8-variable KFRE are valuable tools for predicting the need for vascular access in pre-dialysis patients, outperforming eGFR alone. The 8-variable KFRE, in particular, provides a significant improvement in 6-months ESKD prediction, with potential implications for clinical decision-making and patient management in advanced CKD. These findings advocate for the incorporation of KFRE in the clinical evaluation process for timely and appropriate vascular access planning.

The PIGTAIL paradigm for a fast and safe transfemoral transcatheter aortic valve replacement.

Transfemoral transcatheter aortic valve replacement is the preferred primary access route whenever possible. Despite advancements in expertise and delivery system profiles, complications associated with the primary femoral access still significantly affect procedural morbidity and outcomes. The current standard for accurate main access planning involves proper preprocedural evaluation guided by computed tomography. Several baseline clinical and anatomical features serve as predictors for the risk of vascular injury occurring during or after transcatheter aortic valve replacement. In this paper, we aimed at reviewing the most up-to-date knowledge of the topic for a safe transfemoral access approach according to a paradigm we have called "PIGTAIL."

A call for a sociology of adaptation

A call for a sociology of adaptation

Equity, Equality, Diversity and Inclusion: Bridging Gaps in Access and Participation

There is growing recognition of the importance of equity/equality, diversity and inclusion (EDI) in higher education (HE). Sector-wide there are significant gaps between certain groups of students due to inequalities, and in some cases, these are growing year on year. To tackle these challenges, the HE sector in England is trying to embrace EDI and to widen access and participation through Access and Participation Plans (APPs). This article outlines how one university in England, the University of West London, uses its APP to create opportunities to inspire potential and current students to achieve their goals regardless of their background, identity, and/or lived experiences by ensuring cultural harmony across the student lifecycle where equality and equity co-exists. Through developing its APP in partnership with students, known as Equality Champions, the university seeks assure a diversity of thoughts and voice foster a sense of belonging, promote collaboration and innovation and enhance diverse learning and education.

Abstract PO2-19-04: Trial in Progress: The REJOIN Trial to Use Exercise and Education to Relieve Joint Pain in Older Breast Cancer Survivors Taking Aromatase Inhibitors

Abstract Background: Physical activity (PA) is a recommended part of breast cancer survivorship. PA promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially in reducing joint pain associated with Aromatase Inhibitors (AIs). The purpose of the study is to test if a self-management intervention (including education and exercise instruction) improve joint pain management better than standard care. Trial Design: This two-armed randomized controlled pilot trial (NCT03955627) includes insufficiently active BCS, 60 years and older, diagnosed with stage I-III hormone-sensitive breast cancer, who have completed primary cancer treatment and are within 6 months of initiating AIs. We adapted an evidence-based PA program for older adults (Fit and Strong!) that includes bi-weekly, supervised exercise sessions plus education (90 minutes total). The 16-week, evidence-based intervention program includes: 8-weeks of supervised sessions delivered remotely plus 8-weeks of self-guided home sessions with periodic phone coaching. We are conducting select geriatric assessments (e.g., cognitive assessment, polypharmacy) plus measurements of exercise (both self-reported and objectively measured by accelerometer), joint pain (brief pain inventory), and AI adherence (confirmed by self-report and prescription records) assessed four times (baseline, 4, 6 and 12 months). Eligibility Inclusion criteria: • Female, aged ≥ 60 years at enrollment • Planning to initiate (or are &amp;lt; 24 weeks from initiating) AIs • Diagnosed stages I-III breast cancer • ER+ tumor (at least 5% of cells) • Completed surgery, radiation and/or chemotherapy • Independent ambulator (verified by treating clinician/staff) • Physician approval to start an exercise program • Insufficiently active (less than 150 minutes per week of moderate intensity activity or less than two sessions per week of strength training) • Able to complete surveys and forms/understand English • Agree to random assignment to treatment or control group • Can commit to 8 weeks, bi-weekly classes offered by Zoom video and 8 Weeks of at-home exercise. • Must have internet access or data plan to support video conferencing software • Minimum cognitive impairment (verified by cognitive screening questions administered by phone) Specific Aims: The primary aim is to test the efficacy of a self-management intervention (exercise plus education) on AI-associated arthralgia. Hypothesis: Participants in the treatment group will report less pain than the control group. –A secondary aim is to test the effect of the pilot intervention on adherence to AIs. Hypothesis: Participants in the treatment group will report better AI Adherence than controls. Statistical Methods: We will use the Wilcoxon-Mann-Whitney t-test to assess the effect size from the start to the end of the trial, assuming a power calculation of 80%, a two-sided alpha of 10%, and a pooled standard deviation of one between the outcomes of the two groups (usual care and treatment) being compared. Present Accrual and Target Accrual REJOIN enrolled 12 participants in 2022, but two withdrew after randomization. We now have data on 10 participants with a target accrual of 24 overall. The original 12 were accrued at Penn State College of Medicine. We subsequently opened a second site at Wake Forest University and are recruiting the remaining participants. Contact information: For more information about REJOIN, please contact the study director, Dr. Shirley Bluethmann at sblueth@wakehealth.edu or the REJOIN project manager, Angela Grubb, at agrubb@wakehealth.edu Citation Format: Shirley Bluethmann, Peri Newman, Cristina Truica, Nancy Olsen, Heidi Klepin. Trial in Progress: The REJOIN Trial to Use Exercise and Education to Relieve Joint Pain in Older Breast Cancer Survivors Taking Aromatase Inhibitors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-19-04.

Comprehensive energy solution planning (CESP) framework: an evidence-based approach for sustainable energy access projects in developing countries

Access to affordable, reliable, and modern energy remains a critical goal under the Agenda 2030 for Sustainable Development, especially in remote areas of developing countries. Based on traditional engineering approaches, many energy solution planning tools have been developed to identify the optimal solution in these areas to assess the competition across different technological options. Nevertheless, these approaches, based on an economic optimum, do not necessarily grant long-term sustainability of the solution in specific local contexts, since they are not able to capture the social implications within the Energy-Development nexus. Moreover, also in light of the 2030 Agenda, scientific and grey literature on energy access highlights how energy solutions planning methodologies developed in the last decades need to be complemented by a more comprehensive view, able to integrate evidence from various disciplines, especially engineering and social sciences. Based on the above considerations, this paper introduces a novel framework under the name of CESP, where three social sciences-based phases complement three engineering phases, each one characterized by specific tools, to offer an informed decision framework for the local planner. CESP encompasses a set of techno-economic and socio-technical actions to prevent potential failure as evidenced by a counterfactual analysis used to identify the reasons behind past project failures. The CESP framework presents a sequential and iterative structure that underlines the cyclic perspective of a holistic decision process where social sciences feed the engineering analysis and vice versa. Finally, CESP emerges as a practical and applicable framework for supporting energy access planning in critical areas.

What Is an EEAAP?: Software Accessibility Reviews and User Access

ABSTRACT Academic libraries license thousands of electronic resources and they all might not be fully accessible. Libraries need to be prepared to assist patrons with inaccessible features by putting an equally effective alternative access plan into place. Submitting accessibility reviews, either university mandated or generated from the library, helps ensure that electronic resources meet accessibility standards.

Post-trial access to implantable neural devices: an exploratory international survey

ObjectivesClinical trials of innovative neural implants are rapidly increasing and diversifying, but little is known about participants’ post-trial access to the device and ongoing clinical care. This exploratory study examines...

Studying sports and exercise in England: exploring Level 5 students’ lived experiences of the barriers to their progression and attainment

This discussion piece is a summary of an investigation into the perceived barriers to progression and attainment in Level 5 sport and exercise students (SPO). The study aimed to contribute to the University of Northampton's (UON) strategic aims concerning access and participation, progression, retention and achievement. Using semi-structured interviews it investigated student interpretations of barriers to their progression and attainment. The study aimed to contribute to the gaps identified in the university's Access and Participation Plan (APP). The APP identifies characteristics that are more likely than others to, individually and in combination, impact attainment and progression in university. The APP specifically details access, non-continuation, attainment and progression. Furthermore, it highlights the at-risk groups: Global Ethnic Majority (GEM) students, mature students, disabled students and care leavers. The results of this investigation reveal a complex set of circumstances that contribute to progression, attainment and learning at university. These include balancing external commitments, access to and use of support services, and the need for teaching staff to be approachable and empathetic.

Supporting widening access, continuation and success: the positive impact of the Extended Project Qualification (EPQ)

The Extended Project Qualification (EPQ) is a Level 3, post-16 UK qualification that students usually take alongside A Levels, prior to entering university or the labour market. It plays an important role in improving access to, and success at university. The University of Southampton's Learn with US Transition Programme has developed support particularly for students undertaking the EPQ, who are underrepresented at university. This programme responds to the Office for Students′ (OfS) requirement to develop and submit an Access and Participation Plan (APP). The EPQ challenges the lack of aspiration and deficit discourses that are especially damaging to students from underrepresented backgrounds. Students who complete the EPQ are shown to perform better in terms of Key Stage 5 attainment and at degree level due to developing key academic and research skills prior to enrolment. The Learn with US team is exploring links between EPQ attainment and other institutional goals, such as addressing degree awarding gaps for under-represented students. The University of Southampton takes a whole-institution, lifecycle approach to removing barriers for underrepresented students, and the Learn with US Transition Programme is a key element of our provision that is proven to have positive outcomes for students transitioning into university, especially for those students who are already impacted by structural disadvantage.

Concevoir un centre alimentaire communautaire pour favoriser la sécurité alimentaire

Objective: The objective of this community-based participatory action research (CBPAR) project was to gain an in-depth understanding of the needs, interest and opportunities that exist within a post-secondary institution with respect to supporting food security among students via a food hub. Methods: The project was undertaken on the campus of the University of British Columbia-Vancouver. The CBPAR approach included 4 phases: 1) information gathering, 2) relationship development, 3) implementation of the community engagement strategy, and 4) shareback of findings to the community. Results: Phase 1 identified key components that formed the research process including campus partners for relationship development (phase 2) and subsequent engagement through their networks (phase 3). Phase 3 included engagement of 62, 111, 156, and 154 students, who participated in facilitated dialogues, community meals, a survey and targeted survey, respectively. Food insecurity related experiences were prevalent, with 37% to 75% indicating they worried about running out of food in the last year. Over 90% of all survey respondents affirmed that they would access a community food hub (CFH). Preferences for the CFH were inclusion of emergency food access, community meals, and financial support and planning, while prioritizing foods that meet cultural needs, and a low cost grocery store within the CFH. Conclusion: There is a demonstrated need and desire among students for innovative approaches to support food security at a post-secondary institution. The process outlined may serve as a road map for other communities who are seeking to move beyond emergency food relief.

Port Access Fluidity Management during a Major Extension Project: A Simulation-Based Case Study

The increasing demand for freight services and the use of larger vessels to meet this demand has led to challenges related to storage space and logistics activities, highlighting the need for improvements in port infrastructure for better logistics management. At a crucial phase in its growth, the Port of Trois-Rivières in Canada is planning a major expansion, including the construction of a new terminal to enhance its hosting capacities and freight services. This expansion faces potential access congestion problems during the planned construction, exacerbated by the port’s urban setting. In response to the needs identified by the port authorities for this event, the study’s objective is to assess the implications of increased construction and freight truck flows on access gate fluidity and the impact of additional access infrastructure investment to mitigate potential congestion. These evaluations aim to define effective access management strategies throughout the construction period of the new terminal. To address these complexities, our approach is based on scenario analysis in variants co-constructed with the partner. These scenarios are evaluated using simulation models, configured according to parameters calibrated with a granularity that allows congestion detection. The results enabled an evaluation of the capability of existing and potential gates to manage access. Subsequently, recommendations were shaped in accordance with the expected objectives to manage access traffic effectively. These recommendations concern the optimization of construction activity planning, the layout and planning of access, and the importance of enhanced collaboration between municipal and port authorities for more controlled road traffic management. Recognizing the importance of synchromodality, road network centrality management, and the outsourcing of capacity through inter-port cooperation and with dry ports to manage congestion, these tools will be discussed in this work. The study proposes an approach that reconciles scientific rigor with the implementation constraints of the proposed solutions, allowing this study wider applicability in various port contexts facing challenges in this field of study.

Substance use disorder treatment carve outs in Medicaid managed care

IntroductionMedicaid managed care organizations (MCO) play a major role in addressing the nation's epidemic of drug overdose and mortality by administering substance use disorder (SUD) treatment benefits for over 50 million Americans. While it is known that some Medicaid MCO plans delegate responsibility for managing SUD treatment benefits to an outside “carve out” entity, the extent and structure of such carve out arrangements are unknown. This is an important gap in knowledge, given that carve outs have been linked to reductions in rates of SUD treatment receipt in several studies. To address this gap, we examined carve out arrangements used by Medicaid MCO plans to administer SUD treatment benefits in ten states. MethodsData for this study was gleaned using a purposive sampling approach through content analysis of publicly available benefits information (e.g., member handbooks, provider manuals, prescription drug formularies) from 70 comprehensive Medicaid MCO plans in 10 selected states (FL, GA, IL, MD, MI, NH, OH, PA, UT, and WV) active in 2018. Each Medicaid MCO plan's documents were reviewed and coded to indicate whether a range of SUD treatment services (e.g., inpatient treatment, outpatient treatment, residential treatment) and medications were carved out, and if so, to what type of entity (e.g., behavioral health organization). ResultsA large majority of Medicaid MCO plans carved out at least some (28.6 %) or all (40.0 %) SUD treatment services, with nearly all plans carving out some (77.1 %) or all (14.3 %) medications, mainly due to the carving out of methadone treatment. Medicaid MCO plans most commonly carved out SUD treatment services to behavioral health organizations, while most medications were carved out to state Medicaid fee-for-service plans. ConclusionsCarve out arrangements for SUD treatment vary dramatically across states, across plans, and even within plans. Given that some studies have linked carve out arrangements to reductions in treatment access, their widespread use among Medicaid MCO plans is cause for further consideration by policymakers and other key interest groups. Moreover, reliance on such complex arrangements for administering care may create challenges for enrollees who seek to learn about and access plan benefits.