Distance to junction and small saphenous vein treatment drive risk of ≥grade 2 endothermal heat-induced thrombosis in multicenter practice.

Nipple preservation rates of robot-assisted nipple-sparing mastectomy for breast cancer patients with different tumor-to-nipple distance categories.

Background/Objectives: Intraoral scanners (IOSs) are increasingly used for digital occlusal evaluation; however, the interpretation of IOS-derived occlusal contact distance visualizations remains influenced by registration and alignment factors. This study aimed to compare occlusal contact distance distributions obtained with an intraoral scanner between maximal intercuspation (MIP) and centric relation (CR) under controlled scanning conditions. Methods: Fifteen participants underwent standardized digital bite registration in both mandibular positions. Only scans exhibiting interocclusal overlap ≤ 0.1 mm were included. Occlusal contact distance maps were exported, standardized, and quantified using an open-source image segmentation workflow to calculate the relative area of distance-based contact categories. Paired statistical analyses were performed to compare CR and MIP distributions. Results: No statistically significant differences were observed in the distribution of occlusal contact distance categories between centric relation and maximal intercuspation (p > 0.05). The proportion of very close contact distances remained low in both positions (approximately 6-9%), while moderately close and distant contact distances predominated across all scans, indicating comparable distance-based occlusal visualization patterns under controlled acquisition conditions. Conclusions: Under controlled scanning conditions, IOS-derived occlusal contact distance maps exhibited comparable distribution patterns between centric relation and maximal intercuspation. These findings support the use of intraoral scanning for comparative evaluation of occlusal contact distance distributions, while highlighting the importance of interpreting IOS-derived visualizations within their methodological and technical limitations.

Abstract Background: Black women and uninsured patients have a higher breast cancer mortality rate and are often diagnosed at more advanced stages. Prior research suggests transportation is a barrier to completing recommended treatment. This study examines whether race/ethnicity and insurance status are associated with the distance traveled to breast cancer diagnosis and treatment facilities. Methods: The study employed data from the National Cancer Database (NCDB) from 2013-2022 and included patients who were diagnosed with any stage of breast cancer at Commission on Cancer-certified centers in the United States. Patients with missing information on their racial/ethnic group, distance traveled, or insurance status were not included. Six ordinal categories of distance traveled (<5 miles, 5-9 miles, 10-24 miles, 25-49 miles, 50-99 miles, and >100 miles) were compared across racial/ethnic groups and insurance coverage groups. Z-tests were run to compare each proportion against the white patient group and privately insured patient group, and a chi squared test was run to determine if there was a correlation between insurance status and distance traveled and race/ethnicity status and distance traveled. Results: There was a significantly higher proportion of Black, Hispanic, and Asian American and Pacific Islander (AAPI) patients who traveled under 5 miles to their treatment compared to White patients. 18.8% of Black patients traveled under 5 miles compared to 13% of White patients. However, American Indian and Alaskan Native (AI/AN) patients had a greater proportion of patients that traveled over 100 miles to receive a diagnosis or treatment compared to White patients. Uninsured people were most correlated with shorter distance traveled to facilities, followed by Medicaid then Medicare patients. People with other forms of government insurance had a higher proportion than privately insured patients that traveled 50-99 miles and over 100 miles to facilities. Conclusion: There is a correlation between race/ethnicity and distance traveled and between insurance status and distance traveled with racial and ethnic minority groups and uninsured patients being more correlated with traveling smaller distances. Racial and ethnic minority groups and uninsured patients may lack tools for extensive travel. Even though racial and ethnic minority populations and people without private insurance travel less far than white patients, disparities remain. Further research into how disparities stem from structural racism and shape access to health providers is necessary. Disclaimer: The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator Citation Format: D. Desai. Correlates of Distance Traveled to Treatment Centers Among Breast Cancer Patients: The Role of Race/Ethnicity and Insurance Status [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-11-23.

Preslaughter handling practices, particularly transport and holding conditions, play a crucial role in determining live weight shrinkage in broiler birds, thereby influencing economic losses along the broiler meat supply chain. The present study was conducted to evaluate the effect of preslaughter transport distance on shrinkage loss in live broiler chickens and to assess hourly live weight loss during holding at retail broiler meat shops. Market age broiler birds were transported over three distance categories, namely less than 50 km, 50-100 km, and more than 100 km, under routine commercial conditions. Live body weights were recorded before loading and immediately after unloading to determine shrinkage loss due to transport. Additionally, hourly live bird weight loss was recorded during holding at retail shops from 4:00 am to 10:00 am. Results indicated that preslaughter transport distance significantly influenced shrinkage loss (p≤0.05). Birds transported over less than 50 km exhibited significantly lower shrinkage loss (1.13±0.12%) compared to those transported over 50-100 km (1.89±0.12%) and more than 100 km (1.88±0.08%). However, shrinkage loss did not differ significantly between the two longer transport distances. During holding at retail broiler meat shops, live bird weight loss showed a gradual numerical decline over time; however, differences among holding hours were not statistically significant (p>0.05). The findings demonstrate that preslaughter transport distance is a critical factor contributing to live weight shrinkage in broiler birds, while short-term holding under retail conditions exerts a limited influence on hourly live bird weight loss. These results highlight the importance of optimizing preslaughter transport practices to minimize shrinkage losses in the broiler meat supply chain.

Introduction: Limited evidence exists on whether nutritional knowledge, practice, and supplement use relate to running performance in recreational distance runners. This cross-sectional study examined associations between nutritional knowledge, practice, and supplement use with race time performance among recreational long-distance runners. Methods: A total of 160 recreational runners (72.5% male, mean age not reported) who completed the Hong Kong Marathon 2024 completed an online questionnaire assessing nutritional knowledge, practice, and supplement use. Race times were self-reported. Linear regression and independent t-tests were used to examine associations with completion time. Results: Across all distance categories, correlations between nutritional knowledge and completion time were weak and non-significant (10 km: r = 0.146, p = 0.448; half-marathon: r = 0.228, p = 0.111; full marathon: r = −0.027, p = 0.813). Similarly, correlations between nutritional practice and completion time were weak and non-significant (10 km: r = 0.004, p = 0.985; half-marathon: r = −0.092, p = 0.527; full marathon: r = −0.051, p = 0.649). There were no significant differences in race times between supplement users and non-users in any distance category (10 km: p = 0.818; half-marathon: p = 0.121; full marathon: p = 0.992). A substantial proportion of participants reported poor nutritional knowledge (48.1%) and practice scores (36.9%). Conclusions: This study found no significant associations between nutritional knowledge, practice, or supplement use and race time performance among recreational long-distance runners. The high prevalence of poor nutritional knowledge and practice highlights a need for nutrition education among runners. Future research using objective measures and controlling for training volume and experience is needed.

Vegetation productivity is expected to correlate with species richness, but there is debate about whether the relationship form (non-existent, negative, positive, unimodal) of productivity-species-richness relationships (PSRR) depends on the spatial extent and productivity measure used. Previous assessments employed coarse distance categories to examine scale dependence and did not consider scale dependence for alternative productivity measures. I used spatially varying coefficient models to precisely estimate the distances over which PSRRs change and to map spatial patterns of form for breeding birds across the conterminous United States. I created separate models for three measures summarizing intra-annual estimates of gross primary productivity: sum, minimum, and seasonality (coefficient of variation). Models demonstrated that PSRRs were scale-dependent, and PSRR relationships changed at median distances ranging from 1,010 to 2,184 km depending on the productivity measure. Previously used coarse distance categories would not have resolved the modeled distance estimates. Differences in median distance estimates across productivity measures were not statistically important. Across measures, PSRR form generally alternated between non-existence and positive, but there were pockets where seasonality negatively related to species richness in the western United States. While spatial patterns of form differed across measures, species richness in a small region of the western United States displayed a positive association with all three measures. Spatial patterns were related to prevailing productivity conditions. For example, sum tended to have a positive association with bird species richness in areas characterized by low annual productivity. This study novelly applies spatially varying coefficient models to address the long-debated scale-dependence of PSRR form, and the same approach is broadly applicable across geographies and taxonomic groups.

With the development of remote sensing technologies, the volume of remote sensing data is growing dramatically, making efficient management and retrieval of large-scale remote sensing images increasingly important. Recently, deep hashing for content-based remote sensing image retrieval (CBRSIR) has attracted significant attention due to its computational efficiency and high retrieval accuracy. Although great advancements have been achieved, the imbalance between easy and difficult image pairs during training often limits the model’s ability to capture complex similarities and degrades retrieval performance. Additionally, distinguishing images with the same Hamming distance but different categories remains a challenge during the retrieval phase. In this paper, we propose a novel deep relevance hashing (DRH) for remote sensing image retrieval, which consists of a global hash learning model (GHLM) and a local hash re-ranking model (LHRM). The goal of GHLM is to extract global features from RS images and generate compact hash codes for initial ranking. To achieve this, GHLM employs a deep convolutional neural network to extract discriminative representations. A weighted pairwise similarity loss is introduced to emphasize difficult image pairs and reduce the impact of easy ones during training. The LHRM predicts relevance scores for images that share the same Hamming distance with the query to reduce confusion in the retrieval stage. Specifically, we represent the retrieval list as a relevance matrix and employ a lightweight CNN model to learn the relevance scores of image pairs and refine the list. Experimental results on three benchmark datasets demonstrate that the proposed DRH method outperforms other deep hashing approaches, confirming its effectiveness in CBRSIR.

BackgroundThe Saitama Tone Health and Medical Care Region Medical Collaboration Promotion Council has established a regional medical network system (Patient-Centered Digital Health Records, Tonetto) that shares medical information among healthcare facilities and provides medical services to Tonetto users. This system has facilitated the sharing of medical information between core hospitals, general hospitals, and clinics, thereby contributing to improved medical care. Furthermore, Tonetto has facilitated the availability of patient information for emergency transport. This study aimed to evaluate the impact of Tonetto on emergency transportation times for older patients.MethodsThe study population consisted of 1,820 older patients (aged 65 and over) among 2,542 emergency patients transported to East Saitama General Hospital between January and December 2023. Based on their registration status in the Tonetto system, the patients were divided into two groups: a Tonetto-registered group (n = 319) and a Tonetto-nonregistered group (n = 1,501). Statistical analysis was performed using a general linear model that included main effects and interaction terms for the three categories of transport distance (< 5, 5–10, and ≥ 10 km) and two categories of Tonetto registration status. The difference in transport time was estimated based on Tonetto registration status for each transport distance category. To control for confounding variables, the model included severity, age, sex, and transport distance as covariates.ResultsThe difference in transport time (minutes) between the Tonetto-nonregistered group and the Tonetto-registered group (95% confidence interval) was − 0.3 (− 3.0, 2.4), − 3.5 (− 8.9, 1.9), − 24.3 (− 38.3, − 10.2), respectively. A reduction of 24 min in transport time was observed in the Tonetto-registered group for distances of 10 km or more (p = 0.001).ConclusionsTonetto registration was associated with a substantial reduction in emergency transport time for older patients over long distances. These findings demonstrate the potential of regional medical information networks to improve the efficiency of emergency care and support the development of a nationwide emergency medical information system in Japan.

Successful species conservation and rising tourism in coastal ecosystems lead to more human-wildlife conflicts. Non-invasive conflict mitigation measures are needed to ensure human safety and wildlife conservation. The Helgoland Dune, a small German offshore island, is home to Germany’s largest grey seal (Halichoerus grypus) colony alongside popular tourist beaches, leading to frequent human-seal encounters. Previous physical incidents in the shared swimming zone have raised safety concerns. This study evaluated an acoustic deterrent system (ADS) using Targeted Acoustic Startle Technology (TAST) to reduce such interactions. During two field trials, the ADS emitted pulsed signals (2 s, 700–1500 Hz, 180 dB re 1 µPa) while a camera tracked seal movements. Analysing 22,086 positions via a cumulative link mixed model (CLMM) revealed seals were 3.57 times more likely (odds ratio, CI: 2.38–5.37, p-value < 0.001) to occupy the two farther distance categories (10–25 m, > 25 m) during signal emission, compared to the closest distance zone (< 10 m). Individual variability accounted for 94% (ICC) of behavioural differences. Results provide the first empirical evidence of the ADS’s effectiveness in a recreational context as a non-invasive deterrent tool, while maintaining seal access to surrounding habitat crucial to them.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-17236-2.

Abstract. Airborne measurements of wind speed and direction, temperature, and relative humidity are critical due to their importance for atmospheric processes. Field campaigns with multiple coordinated aircraft present challenges when combining data from each platform due to atmospheric heterogeneity. To confront this issue, this work intercompares for the first time in situ measurements from the Turbulent Air Motion Measurement System (TAMMS) of horizontal winds and temperature and a diode laser hygrometer (relative humidity) deployed on an HU-25 Falcon flying mostly within the marine boundary layer to an independent set of measurements from dropsondes launched from a higher-flying King Air. Leveraging data from 162 joint flights over the northwest Atlantic from these two spatially coordinated aircraft during the NASA Aerosol Cloud meTeorology Interactions oVer the western ATlantic Experiment (ACTIVATE) campaign in winter and summer seasons between 2020–2022, a total of 555 pairs of Falcon–dropsonde data points are identified within 30 km horizontal separation, with minimal vertical separation (usually &lt; 1 m), and within 15 min. This analysis is based on the following range of conditions experienced: altitude = ∼ 0.1–5 km, temperature = −19–27 °C, relative humidity = 1 %–100 %, and wind speed = 0.2–42 m s−1. Based on scatterplots, correlation coefficients, and mean (in situ–dropsonde) error (ME), intercomparisons reveal good agreement for wind speed (r = 0.95, ME = 0.21 ± 1.68 m s−1), u/v wind components (r ∼ 0.96–0.97, ME ∼ 0.03–0.16 (± 1.62–1.67) m s−1), wind direction (r = 0.94, ME = 0.00 ± 0.22 based on cosine of direction angles), temperature (r = 0.99, ME = 0.00 ± 0.71 °C), and relative humidity (r = 0.91, ME = −3.86 ± 10.74 %). Sensitivity analysis shows that binning data into categories of horizontal separation distance, clear versus cloud, winter versus summer, altitude range, and terciles of the values for examined variables did not yield major changes except for relative humidity where there was more deviation, especially above 70 %. The effect of statistics was examined by relaxing the vertical separation distance criteria to expand the number of pairs to over 360 000, without much difference in intercomparison metrics. The effect of averaging more points for each instrument in the final 555 pairs was also shown to lead to minimal change in agreement. Overall, these results provide confidence in both the performance of the measurement techniques compared and combining dropsonde data with in situ data from a separate coordinated aircraft for ACTIVATE, which has relevance to other campaigns with multiple coordinated aircraft conducting similar types of measurements.

BackgroundAnxiety and sleep problems may negatively impact health and athletic performance.MethodsWe conducted a cross-sectional survey study in endurance (≥21.1–42.2 km) and ultra-endurance runners (≥42.2 km), screening for anxiety and sleep problems, assessing potential associated factors and sex differences. Statistical methods included descriptive statistics, testing of group differences with the Kruskal-Wallis H-test, and Dunn’s post-hoc tests, allowing for Bonferroni correction for multiple comparisons, predictive techniques, and regression analysis.ResultsA total of 601 runners participated (female n = 222; male n = 379; mean age 42.8 ± 10.1 years). Overall, 13.5% screened positive for anxiety (female 16.2% compared to men 11.9%; n.s.) and 28.8% for sleep problems (female 32.9% compared to men 26.4%; n.s.). Anxiety and sleep problems were observed significantly more often in half marathon runners (25.2%; (p < 0.001) and 38.3%, (p = 0.02), respectively) compared to marathon (9.8 and 28.4%) and ultramarathon distance runners (11.1 and 28.2%). No statistical differences were found between sexes and performance levels (elite versus non-elite). Associated factors for anxiety included sleep problems (p < 0.001), younger age (<29 years; p < 0.001), years practicing the sport (>10 years; p = 0.006), and distance category (p = 0.03). Associated factors for sleep problems included anxiety (p < 0.001), competition frequency (>4 per year; p = 0.006), and injury-related absences (p = 0.001).ConclusionMental health issues, such as anxiety and sleep problems are common in endurance and ultra-endurance runners and positive screening for anxiety co-existed and was associated with positive screening for sleep problems. This study demonstrates that identifying and screening for anxiety and sleep problems is important, as well as the need for creating awareness, education, preventative strategies, and support services.

Purpose. This study investigates the variation in price elasticity of demand across U.S. domestic air travel markets, with a particular focus on how different distance-based market segments respond to airfare changes. Design / Method / Approach. The analysis presents air travel markets in the distance categories of very short, short-haul, medium-haul, and long-haul to analyze the heterogeneous nature of price responses. Findings. The results indicate substantial differences in elasticity across directions. In the short-haul markets, the negative price elasticity demonstrates strong awareness of fare increases (ε=-0.344). Conversely, long-haul markets demonstrate price elasticity in a positive direction (ε = +1.840), indicating perceptions of value-added (i.e., direct services quality or even network effects). Medium-haul distances suggest nearly neutral responses, and the very short routes produce statistically insignificant elasticity coefficients. Theoretical Implications. The research expands transportation economics and marketing analytics literature through the analytic demonstration that distance travelled does impact demand elasticity in the case of airline routes. The study provides additional evidence for segmentation theories and distance-based price models. Practical Implications. The results provide airline revenue managers with data-based evidence that depicts the opportunity to develop fare structures that align closer to consumer behaviors and may provide opportunities for enhanced profits by utilizing distance and type of flight configurations. Originality / Value. This study employs an entirely unique segmentation-based approach to enable an elasticity analysis of city-pair air travel market distances by utilizing a wealth of longitudinal data to provide evidence-based recommendations for both academics as well as practitioners. Research Limitations / Future Research. Limitations include the exclusion of international routes and ancillary pricing factors. Future research may explore dynamic pricing strategies in real-time or investigate elasticity in the context of loyalty programs and airline alliances. Article Type. Research article. PURL: https://purl.org/cims/4.316

Communication tools in today's era that can be carried anywhere are called gadgets. The use of this modern communication tool occurs as an effort to develop technology in the world. Excessive use of gadgets can trigger eye health disorders that result in computer vision syndrome. The purpose of this study was to determine the relationship between gadget use and visual acuity in students of SDN 1 Banda Sakti, Lhokseumawe City. The cross-sectional approach is the research method used, the measuring instrument used is a snellen chart and a gadget usage questionnaire. The sampling technique used was Stratified random sampling with a total of 152 students as respondents. The results of the analysis using the chi-square test were obtained in the right eye, most respondents with good duration and position of gadget use experienced mild visual acuity disorders while those who were not good mostly experienced moderate visual acuity disorders. For the distance and lighting categories when using gadgets, respondents both experienced moderate visual acuity disorders. For the left eye of respondents with good and bad gadget use, most of them had mild visual acuity disorders. It can be concluded that there is a significant relationship between the duration, position, and distance of gadget use and visual acuity in students of SDN 1 Banda Sakti, Lhokseumawe City.

Objective Improving safety during interactions between motorized two-wheelers (MTWs) and cars is one of the critical aspects for enhancing the road traffic environment. As reported, the most frequent MTW crashes occur when cars pull out in front of an oncoming MTW, often due to conspicuity issues and driver perception errors. While existing studies have focused on perceptual error estimation from pedestrians’ and drivers’ perspective using static visual images and short video clips, the current instrumented vehicle-based study attempts to examine drivers’ perceptions in estimating distance (Experiment 1) and speed (Experiment 2) of an approaching MTW while checking side- view mirrors in dynamic traffic environments. Methods A total of 28 licensed professional car drivers of varying ages were considered for this study. For data collection a camera was mounted on the MTW; and two cameras, a VBOX data logger with GPS, were installed in the car. The glance duration data were collected using driver-facing camera. Additionally, non-parametric test methods were adopted to analyze the mirror effect on drivers’ perception. Results The results of the study indicate that drivers generally tend to overestimate distances while underestimating speeds of motorcycles. Both the distance and speed estimation accuracy decrease with increasing driving speed as well as the longitudinal gap between the vehicles. The perception errors are observed to be more significantly noticeable at higher speeds exceeding 40 kmph or when the MTW is in the farthest distance category. Interestingly, our study also indicates that shorter mirror glance duration may contribute to these higher perception errors. The results were consistent for both the side-view mirrors, although the errors were more pronounced in the passenger’s side mirror, highlighting the possible impact of longer eye-to-mirror distance. Conclusions Due to perception errors, MTW riders often think that they had ample time and space for maneuvers, leading to risky decision-making and increasing potential collisions. Our findings emphasize the effect of mirror usage in decision-making tasks while driving, underscoring the necessity for enhanced driver training programs and redesigned mirror curvature to make a safer road environment.

Cow factors to address when performing avoidance distance tests at the feeding rack.

This paper reports on the development of L2 English vowel pair perception by adult L1 Spanish/Basque speakers of differing levels of English instruction. This study focuses on vowel pairs /i-ɪ/, /u-ʊ/ and /ʌ-ɔ/, with differing levels of proximity to native categories. Results of two perceptual tasks show that learners are influenced by their native categories, but that regardless of level, they can still modify their representations. However, the success in categorization varies by sound based on acoustic distance and multiple category competition.

Trauma patients frequently may be transported significant distance to receive care at a level one trauma center. Increasing distance may cause delays in care. We sought to investigate whether distance traveled for level 1 trauma care affected rates of intervention for renal trauma. We queried our institutions reportable trauma database from the years 2015 to 2022. This data was filtered for all patients that had ICD codes pertaining to renal trauma. All renal trauma patients with zip codes where they sustained their injury were included. We then calculated the distance traveled to our hospital via Google Maps for each patient. We aggregated diagnosis codes for percutaneous angioembolism and nephrectomy. Injury severity scores (ISS) were collected. We divided patients into two groups based on distance traveled (0-30 miles and 31 + miles). We also analyzed the number of angioembolizations and open renal surgery completed for each mile distance category and analyzed for a difference between the groups. Our database yielded 307 cases of renal trauma that met inclusion criteria. We found no difference in rates of percutaneous angioembolism and open renal surgery between patients that traveled different distances for renal trauma care. Few studies have assessed distance traveled for trauma care and need for intervention. Our findings that an increased travel distance did not lead to a significantly increased risk for intervention are reassuring. Based on these findings, distance traveled for appropriate trauma care may not be a factor when deciding on transfers for renal trauma.

In vitro embryo production has increased over the last years as a tool to obtain genetically superior animals. Anti-Müllerian hormone (AMH) concentration and antral follicle count are phenotypes associated with in vitro embryo production but are less accessible at the farm level. Anogenital distance (length from the center of the anus to the base of the clitoris) has been proposed as a new proxy for fertility in dairy cattle that can be collected easily and at a low cost. Bos indicus dairy cattle oocyte donors of the Gyr breed (n = 552) from six herds in Brazil were used to test the association of the historical in vitro embryo production record with anogenital distance and AMH. The historical record of embryo production was retrieved from the farms, and anogenital distance and blood samples to evaluate the concentration of AMH were collected in 2021. Donors were classified as High or Low AMH, High or Low recovered oocytes, and Short or Long anogenital distance categories. Donors in the High AMH and oocyte categories produced more viable oocytes and embryos than donors in the Low AMH and oocyte categories. However, no differences were observed between Short vs. Long anogenital distance for AMH concentration and in vitro embryo production. A limitation of our study was the use of oocyte and embryo data collected retrospectively in relation to the current anogenital distance of the animal. Thus, further studies should be performed to validate these results and to better understand the association between anogenital distance and in vitro embryo production.

Background: Participation in cardiac rehabilitation (CR) is enhanced by proximity to CR facilities and communication between inpatient and outpatient settings but may become fragmented when patients are distant from their discharging hospital and nearest CR facility. Research Question: This study investigates how patient distance to both hospitals and CR facilities impacts the rates of CR participation. Methods: This study included 100% Medicare fee-for-service claims for beneficiaries with 12 months of continuous Part A/B coverage who had coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or surgical or transcatheter aortic valve replacements (SAVR or TAVR) between 07/2016-12/2018, excluding patients discharged to hospice or died within 30 days. Google Maps defined travel distances from the patient to hospital and CR facility locations using geographic centroids of ZIP codes, which were then categorized into quartiles. CR enrollment was defined as attending at least one session within one year of discharge. Logistic regression models estimated marginal CR enrollment rates across both hospital and CR facility distance categories adjusting for patient, hospital, and regional factors. Results: The study included a total sample of 501,049 beneficiaries undergoing PCI (62%), CABG (19%), SAVR (7%), and/or TAVR (15%). The median travel distance to the hospital was 18.6 miles (IQR 8.2-43.3 miles) and to the CR facility was 7.7 miles (IQR 2-15.3 miles). A total of 188,963 (37.7%) beneficiaries attended at least one CR session, which varied across categories of distance to hospital (Q1: 36.8% to Q4: 37.5%) and CR facility (Q1: 44.7% to Q4: 30.0%, p&lt;0.01). Adjusted CR enrollment rates improved when beneficiaries lived farther from their admitting hospitals but closer to CR facilities (Figure 1), with the highest enrollment for those located farthest from their admitting hospital but closest to the CR facility (47.5%) and lowest enrollment among those closest to the hospital but farthest from the CR facility (20.6%). Conclusions: Greater distance to the admitting hospital was associated with higher CR enrollment, while greater distance to the CR facility was associated with lower enrollment among eligible Medicare beneficiaries. Addressing geographic barriers to CR participation may require tailored solutions based on patient proximity to hospitals and CR facilities.