Accessibility Measures Research Articles

Abstract PS18-02: Prevalence of Refusal of Recommended Cancer Treatments and Survival Differences in Breast Cancer Patients: Analysis of the National Cancer Database

Abstract Background: Some breast cancer patients (pts) refused treatment despite their providers’ recommendations. Treatment refusals can be detrimental to these pts’ short- and long-term health outcomes. Limited research has investigated the national trends in treatment refusals and their impacts on the survival of breast cancer pts. Methods: We analyzed data collected from breast cancer pts in the 2004-2020 National Cancer Database (NCDB). Four treatment modalities were assessed: chemotherapy (CT), hormone therapy (HT), radiotherapy (RT), and surgery. The CT cohort included stage I-IV pts. The HT cohort included stage I-IV, hormone receptor-positive pts. The RT or surgery cohort was limited to only stage I-III pts. Refusal status was categorized as “yes/no,” and its correlates were assessed using multivariable logistic regression. Estimated rates of overall survival (OS) were calculated using the Kaplan-Meier method. The association between refusal status and OS was examined using log-rank tests, followed by multivariable Cox regression models. Results: In the CT cohort, 9.6% of 1,296,488 pts who were offered the treatment refused. In the RT cohort, 6.1% of 1,635,916 pts refused. In the HT cohort, 5.0% of 1,893,339 pts refused. In the surgery cohort, only 0.6% of 2,590,963 pts refused. Significant increasing trends in treatment refusals from 2004-2020 across the four treatment modalities were observed (all p-trends < .001). We found significant differences in age, race, AJCC stage group, molecular subtype, tumor grade, and care access indicators (e.g., insurance, median household income, facility type, and rural/urban area) by refusal status. Black pts were more likely than White pts to refuse surgery (adjusted odds ratio [AOR] 2.01, 95% CI: 1.89-2.14). Asian or Pacific Islander pts were also more likely to refuse surgery (AOR 1.29, 95% CI: 1.15-1.44) and CT (AOR 1.21, 95% CI: 1.16-1.27). Uninsured pts were more likely than privately insured pts to refuse surgery (AOR 4.83, 95% CI: 4.22-5.51), RT (AOR 1.97, 95% CI: 1.83-2.12), CT (AOR 1.61, 95% CI: 1.51-1.72), and HT (AOR 1.61, 95% CI: 1.49-1.73). Compared with pts who did not refuse treatment, those who refused had lower rates of 5-year OS in the cohorts of HT (81.4% vs. 88.4%), CT (74.9% vs. 84.4%), RT (74.4% vs. 90.8%), and surgery (42.0% vs. 88.1%). When stratified by stage, similar patterns of 5-year OS rates were observed across all cohorts. After adjusting for sociodemographic and clinicopathologic factors, pts who refused surgeries had a higher mortality risk than those who did not (aHR 2.91, 95% CI: 2.82-3.01). Pts who refused RT had a higher risk of dying than those who did not (aHR 1.97, 95% CI: 1.93-2.01). Pts who refused CT had a greater risk of dying than those who did not (aHR 1.86, 95% CI: 1.83-1.90). Pts who refused HT had a greater risk of death than those who did not (aHR 1.56, 95% CI: 1.53-1.59). Black pts had higher mortality risk than their White counterparts across all cohorts (HT: aHR 1.15, 95% CI: 1.13-1.17; CT: aHR 1.14, 95% CI: 1.12-1.16; RT: aHR 1.11, 95% CI: 1.1.09-1.14; surgery: aHR 1.10, 95% CI: 1.08-1.11). Conclusions: In this sample of breast cancer pts, the rate of treatment refusal was highest for CT and lowest for surgery, and there were significantly increased trends in refusals over time. Age, race, stage, molecular subtype, tumor grade, and care access measures were independently associated with treatment refusals, suggesting that differential refusals not only are affected by biological factors but also may reflect disparities in socioeconomic status. Furthermore, pts who refused treatment experienced worse OS, regardless of treatment modality. These findings suggest that stressing the importance of recommended treatment and interventions tailored for this patient population may be needed to improve their survival outcomes. Citation Format: Jincong Freeman, James Li, Susan Fisher, Katharine Yao, Sean David, Dezheng Huo. Prevalence of Refusal of Recommended Cancer Treatments and Survival Differences in Breast Cancer Patients: Analysis of the National Cancer Database [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 PS18-02.

Development of a multidimensional measure of health care access among LGBTQ midlife and older adults in the United States

PurposeLesbian, gay, bisexual, transgender, and queer (LGBTQ) midlife and older adults are a health disparity population whose health and health care needs are distinguished by the intersection of gender, sexuality, and age. Research and measurement considering multidimensional factors influencing health care access among this population, however, remain limited. Theoretically cohesive indicators of health care access were combined to develop a comprehensive and reliable, yet parsimonious scale that assesses the unique health care access needs and experiences of LGBTQ midlife and older adults. MethodsData from the U.S.-based Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) were used, including 2322 LGBTQ participants from the 2015 wave of data collection. Twenty-four items were initially included in an assessment of scale reliability. The underlying factor structure of health care access was tested. Differences in mean health care access scores were examined across sexual identity, current gender, gender identity, and age cohort. ResultsNineteen items remained in the final scale (α=0.90). Data supported health care access as multidimensional among NHAS participants. Heterogeneity in health care access scores was identified across participants. Bisexual, straight, and sexually diverse participants, women and gender diverse participants, and transgender participants faced more difficulties accessing care. Participants aged 66–80 and 81+ reported significantly higher health care access scores. ConclusionFinal indicators represented the complex health care experiences of LGBTQ midlife and older adults. This scale can be utilized in future health equity research. Using NHAS longitudinal data, future research could assess changes in access over the life-course and as a predictor of health outcomes.

Spatial Accessibility Measures for Egyptian Cities' Urban Parks Utilizing GIS-Based Methods

Spatial Accessibility Measures for Egyptian Cities' Urban Parks Utilizing GIS-Based Methods

Mapping coexisting hotspots of multidimensional food market (in)accessibility and climate vulnerability

With the increasing likelihood of agricultural production failures under a warmer global climate, the importance of markets in providing access to nutrient-dense foods (NDFs) through trade is predicted to grow. However, regions with relatively poor access to markets and supporting infrastructures (e.g. roads and storage facilities) are potentially ill-equipped to deal with both short-term hydrometeorological hazards such as droughts and floods, and longer-term shifts in agricultural productivity. Despite the increasing focus upon markets within academic and policymaking circles, a regional-scale assessment of these potentially coexisting hotspots of vulnerability has not been conducted. We conduct a two-stage geospatial analysis integrating three publicly available datasets across the Indian states of Bihar, Chhattisgarh, Jharkhand, and Odisha. Combining the 2011 national census with the new PMGSY-GeoSadak database, we conduct nearest neighbour analysis to measure multidimensional market inaccessibility by: (i) distance from a settlement to its nearest village, town or city with a market, (ii) distance from a settlement to its nearest major road, and (iii) distance from a settlement to its subdistrict headquarters. We then correlate these measures with India’s only district-wise assessment of climate vulnerability to identify hotspots of market inaccessibility and climate hazards. We find that the three market access measures are spatially autocorrelated and positively interrelated at the settlement (n = 129 555) and district (n = 107) levels, meaning that settlements located further from their nearest market tend to experience poorer road connectivity and access to the subdistrict economic hub. Approximately 18.5-million people live in districts with relatively high climate vulnerability and relatively high and multidimensional market inaccessibility. Hotspots of coexisting vulnerabilities are also disproportionately populated by ‘Schedule Castes and Schedule Tribes’ (SC/ST) communities. The identification of coexisting hotspots has important implications for the development of equitable and resilient markets that bolster NDF access for climate vulnerable and nutritionally insecure populations.

P121 Understanding barriers to digital inclusion from Urdu speakers’ perspective: remote monitoring of rheumatoid arthritis

Abstract Background/Aims Chronic musculoskeletal conditions are more prevalent in South Asian (SA) communities, particularly for women and older adults, who face existing barriers in accessing healthcare services. Remote patient monitoring (RPM) has the potential to enhance management of long-term conditions like rheumatoid arthritis, offering insights into disease activity and supporting shared decision-making. However, SA communities in the UK and elsewhere, are commonly underrepresented in the development and evaluation of digital health technologies where language and other barriers may limit adoption and use. This research aimed to explore perspectives of Urdu speaking members of South Asian communities on barriers for engaging with RPM using an app designed for people with rheumatoid arthritis (RA). The focus on Urdu speakers provides an example to ensure RPM benefits South Asian communities, and particularly where language may be a barrier. Methods The study included nine participants, primarily females with one male participant, aged 55-75, who were Urdu speakers and diagnosed with or suspected of having RA. They were recruited from community organisations in Greater Manchester and introduced to the RPM app for monitoring symptoms. Semi-structured interviews were conducted in Urdu to investigate barriers to digital inclusion. The interviews were transcribed and analysed in Urdu (by Urdu speaking members of the team) with selective translation into English. Thematic analysis was used to identify themes and subthemes related to digital exclusion and strategies for addressing these issues. Results Participants’ responses were themed into five key areas concerning digital inclusion and potential solutions: 1. Existing use of digital devices and resources ; most expressed limited use of digital technology in day to day living, 2. Concerns about privacy ; some expressing caution and lack of confidence in security, 3. Views about symptom tracking; many were positive about tracking symptoms to share with doctors, though some said they would not want the constant reminder of their condition, 4. Barriers to engagement with the app; women, older individuals, and those with limited tech exposure, emphasizing the need for translated versions and family support, 5.Social Support to engagement with technology; Suggestions included workshops to improve digital literacy, translated materials (including audio) and reminders, as well as family support. Conclusion The study revealed challenges faced by women, older individuals, and those with limited tech exposure when using the app, emphasizing the need for translated versions and family support. The study also highlighted a need to consider intersectional dimensions of inequality for tailoring solutions. Overall, the study emphasizes the significance of tailored support and accessibility measures for the diverse communities like SA Urdu community when implementing digital health solutions. Disclosure Y. Masood: None. S. Ali: None. H. Chadwick: None. K. Staniland: None. S. van der Veer: None. W. Dixon: Consultancies; WGD has received consultancy fees from Google unrelated to this work. C. Sanders: None.

Temporal Variation and Spatial Heterogeneity in Boarding/Alighting Patterns at Urban Railway Stations: Implications for Estimating Optimal Construction Scale—A Case Study in Seoul, South Korea

Urban railways have become a prominent mode of public transportation within cities owing to their connectivity with other modes of transport and environmental friendliness. Various policies, such as the expansion of metropolitan areas and the development of megacities, have further emphasized the pivotal role of urban railways. Consequently, more railway stations are expected to be constructed in developed cities. However, the temporal variation in boarding and alighting patterns at each railway station is often overlooked. Failing to account for this variation, specifically the differences in peak-hour concentration rates, in railway station design may cause increased conflicts among users owing to concentrated demands during specific time periods, exacerbating congestion and diminishing the appeal of the urban railway systems. Therefore, this study investigated the correlation between the temporal variation in boarding and alighting patterns and the attributes (location) of railway stations in Seoul, South Korea, and analyzed the spatial heterogeneity of this correlation. Initially, the factors influencing the peak-hour concentration rates in railway stations were identified using a linear regression model. Peak hours were defined as morning and afternoon peaks and boarding and alighting were differentiated to account for the directional aspects of temporal variations in boarding and alighting patterns. The correlation between boarding and alighting patterns and the attributes of railway station influence zones was determined, and a geographically weighted regression model was estimated to analyze the spatial heterogeneity of this correlation based on railway station location. The analysis results revealed that railway stations in the southeastern and downtown areas of Seoul exhibited varying impacts of station attributes on boarding and alighting patterns even when the station attribute influence zones were identical. The contribution of this study is to evaluate the priorities of railway projects and its corresponding transportation policies. Regarding the policy goal recently announced by the Korean government, “Achieving Commute Times in 30-min range,” our finding will provide a good measure of accessibility whether it succeeds or not.

The fuel of discontent? Transport poverty risks and equity concerns in French urban peripheries

A range of accessibility indicators has been developed in the past decade to evaluate equity in transportation within urban areas. Some studies have attempted to incorporate them in transport poverty metrics, focussing on insufficient access to general services and employment. While accessibility measures coupled with statistics have been effective in assessing immediate households’ vulnerability, we argue that an analysis of their adaptive capacity could contribute to a better information of local policies in the long term. This paper aims to develop a methodology for mapping transport poverty risks at the metropolitan scale, while studying the relation between urban segregation and the transport divide. We use the case study of Lyon to operationalise our method and find evidence of vulnerability patterns previously identified in the sociological literature. Beyond the sensitivity of households living in the first-crown neighbourhoods and the growing exposure of medium-income families settling in peripheral municipalities, we emphasise the importance of using mixed methodologies to better capture households’ needs and mobility choices within suburban environments. We conclude by discussing shortcomings and future developments of our research.

Airport–Industry–City Integrated Accessibility Using Big Data Case View from Beijing Capital International Airport

Big data technology can help collect, analyze, and process large-scale transportation, population, economic, and other relevant data, which has been proven to be more accurate in assessing the accessibility of different areas. An aerotropolis is composed of the airport as the core, airport-related industry as the link, and the airport-oriented city as the carrier, airport–industry–city (AIC) system. To better grasp the development quality of aerotropolises, an AIC integrated accessibility measurement model is constructed comprising the accessibility of airport route network, airport ground traffic, and airport information coverage. Using big data of traffic, network and information from 2001 to 2020, we apply the model to the Beijing Capital International Airport (PEK) aerotropolis. The results show that PEK’s AIC connectivity exceeded 1 for the first time in 2008, reaching 1.0890, which the range of the scale is [0, +∞]. It fluctuated significantly from 2017 to 2020, showing a double life-cycle S-curve. So, the PEK aerotropolis’ development can be divided into four stages: germination (before 2001), high-speed development (2002–2011), gradual formation (2012–2019), and “seeking change in the process of change” (after 2020). Our model offers a new tool for identifying the development stages of aerotropolises and for improving connectivity—namely, improving the accessibility of the airport node network, the layout of airside-preferring enterprises, and the network structure of new Internet-based airport cities. Obviously, the AIC integrated accessibility can indeed guide the scientific development of an aerotropolis.

O2 Saturation Predicted the ICU Stay of COVID-19 Patients in a Hospital at Altitude: A Low-Cost Tool for Post-Pandemic.

Background and Objectives: Patients at high altitudes with COVID-19 may experience a decrease in their partial oxygen saturation (PO2S) levels. The objective was to assess the association between PO2S and intensive care unit (ICU) stay in patients at high altitudes with COVID-19. Materials and Methods: Clinical records of 69 COVID-19 patients (36% women) admitted to the ICU were analyzed. Median values were considered for intra-group categories ("≤11 days" and ">11 days" in the ICU) and for PO2S height categories ("<90%" and "≥90%"). Logistic regression and linear regression models adjusted for confounding variables were used. Results: Patients with >11 days in the ICU had 84% lower odds of having a PO2S ≥ 90% (OR: 0.16 [CI: 0.02, 0.69], p = 0.005) compared to those with ≤11 days in the ICU. An increase in PO2S by 1% reduced ICU stay by 0.22 days (β: -0.22 [CI: -0.33, -0.11], p < 0.001), potentially leading to a reduction of up to 1.44 days. Conclusions: PO2S is a crucial factor in estimating ICU stays for COVID-19 patients at high altitudes and serves as an accessible and cost-effective measure. It should be used in infected patients to complement the prognosis of post-pandemic ICU stay.

Factors associated with repeat emergency department visits for mental health care in adolescents: A scoping review

ObjectivesThe aim of this review was to identify factors associated with multiple visits to emergency department (ED) services for mental health care in adolescents. MethodsElectronic databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and ProQuest Dissertations & Thesis Global) were searched for evidence that presented an association between risk factors or correlates of multiple visits to the emergency departmental for mental health care by 10–24 year olds. High impact use was defined as at least one return ED visit for mental health care. Primary studies of any quantitative design were included, with no exclusions based on language or country and all possible risk factors were considered. Data were extracted and synthesised using quantitative methods; frequencies of positive, negative and null associations were summarised for categories of potential risk factors. ResultsSixty-five studies were included in the review. Most studies were from North America and reported a wide range of measures of high impact ED use, the most common being a binary indicator of multiple ED visits. Sex/gender and age were the most frequently reported risk factors. Measure of previous or concurrent access to mental health care was consistently positively associated with high impact use. Having private health insurance, compared with public or no insurance, was generally negatively associated with high impact use. Proxy measures of socioeconomic position (SEP) showed associations between lower SEP and more high impact use in a small number of studies. No other factors were consistently or uniformly associated with high impact use. ConclusionsThe review identified a substantial evidence base but due to the variability in study design and measurement of both risk factors and outcomes, no consistent risk factors emerged. More research is needed, particularly outside North America, using robust methods and high quality routinely collected data.

Mobility Energy Productivity Evaluation of On-Demand Transit: A Case Study in Arlington, Texas

On-demand transit (ODT) systems are increasing in number and size. To evaluate and quantify outcomes, the research team utilizes the mobility energy productivity (MEP) metric, which is a holistic accessibility measure, to analyze and compare the mobility of various transportation modes in Arlington, Texas. The MEP tool is applied to the ODT system in Arlington, Texas, as well as to five existing transportation modes (driving, transportation network company, transit, biking, and walking). Six ODT scenarios are also analyzed and compared. The analysis is focused on the opportunities that an ODT system presents for transportation disadvantaged communities (DACs) with low rates of car ownership. Although driving received the highest MEP score—a finding typical for a U.S.A. city— the results for the ODT system reveal that it serves those in DACs effectively, helping to achieve an equity design goal. ODT improved the average MEP score across the service area by 83% when considering only accessible, nonprivate vehicle modes (biking, transit, and ODT). For the ODT scenarios, decreasing the wait time by 50% compared with the baseline scenario led to a nearly 160% increase in the MEP score, whereas increasing the ODT travel speed by 21% led to an 80% improvement in the MEP score. As analyzed through the MEP tool, this paper demonstrates how ODT can enhance mobility, particularly for DACs. The results of an MEP analysis can be used by researchers and transit agencies to compare transportation modes and improve the effectiveness of transportation systems across a service area.

The genetic regulatory architecture and epigenomic basis for age-related changes in rattlesnake venom

Developmental phenotypic changes can evolve under selection imposed by age- and size-related ecological differences. Many of these changes occur through programmed alterations to gene expression patterns, but the molecular mechanisms and gene-regulatory networks underlying these adaptive changes remain poorly understood. Many venomous snakes, including the eastern diamondback rattlesnake (Crotalus adamanteus), undergo correlated changes in diet and venom expression as snakes grow larger with age, providing models for identifying mechanisms of timed expression changes that underlie adaptive life history traits. By combining a highly contiguous, chromosome-level genome assembly with measures of expression, chromatin accessibility, and histone modifications, we identified cis-regulatory elements and trans-regulatory factors controlling venom ontogeny in the venom glands of C. adamanteus. Ontogenetic expression changes were significantly correlated with epigenomic changes within genes, immediately adjacent to genes (e.g., promoters), and more distant from genes (e.g., enhancers). We identified 37 candidate transcription factors (TFs), with the vast majority being up-regulated in adults. The ontogenetic change is largely driven by an increase in the expression of TFs associated with growth signaling, transcriptional activation, and circadian rhythm/biological timing systems in adults with corresponding epigenomic changes near the differentially expressed venom genes. However, both expression activation and repression contributed to the composition of both adult and juvenile venoms, demonstrating the complexity and potential evolvability of gene regulation for this trait. Overall, given that age-based trait variation is common across the tree of life, we provide a framework for understanding gene-regulatory-network-driven life-history evolution more broadly.

PROBLEMS AND PECULIARITIES OF CREATING A MODERN BARRIER-FREE ARCHITECTURAL ENVIRONMENT IN CHINA

Creating an accessible environment is not just a matter of convenience; it is a fundamental indicator of a nation’s level of civilisation and social development. China has significantly improved its barrier-free architecture construction system since the early 1980s. This progress commenced with the enactment of legislation focused on constructing accessible environments, particularly in major urban centres where accessibility standards are generally higher. However, despite these advancements, several challenges persist. One notable issue is the limited public awareness regarding the critical role of creating spaces that accommodate diverse needs. In addition, there is insufficient oversight over the implementation of accessibility measures, leading to inconsistencies in design and execution. These issues underscore the necessity for systemic solutions. Addressing them requires a comprehensive approach encompassing legislative reforms, enhanced enforcement mechanisms, and proactive awareness campaigns. By focusing on these challenges and developing effective strategies to overcome them, China can elevate the construction of barrier-free environments to new heights. The article delves into the intricacies of creating barrier-free architectural environments in China, shedding light on the systemic issues hindering progress. Among these challenges are legislative gaps, inadequate control mechanisms, and a lack of widespread understanding of accessibility needs. As a solution, the article offers recommendations for bolstering the legislative framework, improving enforcement mechanisms, and increasing public awareness through targeted propaganda efforts. Emphasising collaboration between governmental bodies and civil society organisations is crucial to successfully implementing these recommendations. In conclusion, the pursuit of accessible environments in China represents a practical endeavour as much as a symbolic gesture towards inclusivity and social progress. Through concerted efforts and strategic interventions, the nation can pave the way for a future where accessibility is not just a privilege but a fundamental right for all citizens. Keywords: barrier-free architectural environment, barrier-free design, accessible spaces, inclusive architecture.

Assessing the spatial distributions of public electric vehicle charging stations with emphasis on equity considerations in King County, Washington

This study assessed the availability and accessibility of public electric vehicle (EV) charging stations at the census tract level in King County, Washington, USA. A gravity model was used to measure the accessibility of stations in each tract while considering the competition among tracts for charging infrastructure. Unlike prior studies, we evaluate current distribution from various equity viewpoints, clearly defining these perspectives and investigating their implications for charging distribution. The findings revealed significantly higher accessibility of public stations in areas with a lower share of single-family homes, a higher share of commercial areas, and proximity to major roadways, irrespective of population and EV adoption rates. Moreover, we found that the current distribution is consistent with utilitarian and capabilities-based theories of equity. Spatial tools such as Moran's I and spatial regression were used to analyze the spatial disparity of the proposed accessibility measure, showing the existence of a highly clustered spatial distribution. This study offers valuable insights into integrating equity considerations in assessing accessibility to transportation facilities, especially EV charging stations. Such an approach can facilitate the promotion of EV adoption across diverse groups, a critical factor in achieving sustainable city development goals by mitigating carbon emissions and enhancing mobility.

A Conserved Intramolecular Ion-Pair Plays a Critical but Divergent Role in Regulation of Dimerization and Transport Function among the Monoamine Transporters.

The monoamine transporters, including the serotonin transporter (SERT), dopamine transporter (DAT), and norepinephrine transporter (NET), are the therapeutic targets for the treatment of many neuropsychiatric disorders. Despite significant progress in characterizing the structures and transport mechanisms of these transporters, the regulation of their transport functions through dimerization or oligomerization remains to be understood. In the present study, we identified a conserved intramolecular ion-pair at the third extracellular loop (EL3) connecting TM5 and TM6 that plays a critical but divergent role in the modulation of dimerization and transport functions among the monoamine transporters. The disruption of the ion-pair interactions by mutations induced a significant spontaneous cross-linking of a cysteine mutant of SERT and an increase in cell surface expression but with an impaired specific transport activity. On the other hand, similar mutations of the corresponding ion-pair residues in both DAT and NET resulted in an opposite effect on their oxidation-induced dimerization, cell surface expression, and transport function. Reversible biotinylation experiments indicated that the ion-pair mutations slowed down the internalization of SERT but stimulated the internalization of DAT. In addition, cysteine accessibility measurements for monitoring SERT conformational changes indicated that substitution of the ion-pair residues resulted in profound effects on the rate constants for cysteine modification in both the extracellular and cytoplasmatic substrate permeation pathways. Furthermore, molecular dynamics simulations showed that the ion-pair mutations increased the interfacial interactions in a SERT dimer but decreased it in a DAT dimer. Taken together, we propose that the transport function is modulated by the equilibrium between monomers and dimers on the cell surface, which is regulated by a potential compensatory mechanism but with different molecular solutions among the monoamine transporters. The present study provided new insights into the structural elements regulating the transport function of the monoamine transporters through their dimerization.

Solid-state nuclear magnetic resonance in the structural study of polyglutamine aggregation.

The aggregation of proteins into amyloid-like fibrils is seen in many neurodegenerative diseases. Recent years have seen much progress in our understanding of these misfolded protein inclusions, thanks to advances in techniques such as solid-state nuclear magnetic resonance (ssNMR) spectroscopy and cryogenic electron microscopy (cryo-EM). However, multiple repeat-expansion-related disorders have presented special challenges to structural elucidation. This review discusses the special role of ssNMR analysis in the study of protein aggregates associated with CAG repeat expansion disorders. In these diseases, the misfolding and aggregation affect mutant proteins with expanded polyglutamine segments. The most common disorder, Huntington's disease (HD), is connected to the mutation of the huntingtin protein. Since the discovery of the genetic causes for HD in the 1990s, steady progress in our understanding of the role of protein aggregation has depended on the integrative and interdisciplinary use of multiple types of structural techniques. The heterogeneous and dynamic features of polyQ protein fibrils, and in particular those formed by huntingtin N-terminal fragments, have made these aggregates into challenging targets for structural analysis. ssNMR has offered unique insights into many aspects of these amyloid-like aggregates. These include the atomic-level structure of the polyglutamine core, but also measurements of dynamics and solvent accessibility of the non-core flanking domains of these fibrils' fuzzy coats. The obtained structural insights shed new light on pathogenic mechanisms behind this and other protein misfolding diseases.

Development of a Variable Multimodal Balanced Floating Catchment Area Approach for Spatial Accessibility Assessment

Rapid urbanization and expansion, stemming from demographic growth and migration from rural areas to urban centers, have heavily strained cities in recent years. These circumstances have created an ever‐growing need for equipment and essential services. On the other hand, previous research has shown that accessibility measurement is a powerful technique for assessing urban compactness. This assessment arises from the willingness of urban planners to develop transport services and land use across various cities globally. This paper addresses the computational problem of spatial accessibility, focusing on the influence of private cars versus public transport. We introduced a metric that enhances the Balanced Floating Catchment Area (BFCA) index. Our metric not only considers multiple transportation modes in the calculation of spatial accessibility but also takes into account variable catchment sizes. We applied our metric in a case study examining spatial accessibility to public hospitals in Casablanca. The results provide a geographic breakdown of each transportation mode, and the accessibility of different scenarios has been compared.

Measuring spatial inequality of urban park accessibility and utilisation: A case study of public housing developments in Auckland, New Zealand

Poor spatial accessibility of urban green spaces affects disadvantaged populations, who are at greater risk of socioeconomic related health inequalities. We analyse mobile phone locational data from the Auckland Region of New Zealand to connect a user's 'home' location to nearby urban parks, specifically focusing on public housing tenants - a highly vulnerable group at greater risk of health inequalities.We use a number of traditional accessibility measures and four new park utilisation analyses to explore the relationship between accessibility to urban parks, neighbourhood area deprivation, and user's patterns of actual park usage. We develop four new metrics to assist in understanding the actual utilisation of green spaces available to residents: distance between closest park available and visited (DAT), used park opportunities (UPO), locality of park visits (LPV), and nearest park visitation rate (NPVR).We found that neighbourhoods with the most public housing tend to have a lower number of parks accessible, and those that are accessible are smaller in size. Additionally, people living in these areas tend to travel farther to access urban parks compared to areas with no public housing. More deprived neighbourhoods were revealed to have lower accessibility to urban greens in Auckland, highlighting the urgency to address the emerging divisions in accessibility and opportunities for these neighbourhoods. Our findings have important implications for policy-makers and urban planners. Furthermore, the use of mobile phone locational data can reveal insights into the mobility behaviour of users and can be applied to other locations and population groups.

Assessing multimodal emotion recognition in multiple sclerosis with a clinically accessible measure

BackgroundMultiple sclerosis (MS) negatively impacts cognition and has been associated with deficits in social cognition, including emotion recognition. There is a lack of research examining emotion recognition from multiple modalities in MS. The present study aimed to employ a clinically available measure to assess multimodal emotion recognition abilities among individuals with MS. MethodThirty-one people with MS and 21 control participants completed the Advanced Clinical Solutions Social Perceptions Subtest (ACS-SP), BICAMS, and measures of premorbid functioning, mood, and fatigue. ANCOVAs examined group differences in all outcomes while controlling for education. Correlational analyses examined potential correlates of emotion recognition in both groups. ResultsThe MS group performed significantly worse on the ACS-SP than the control group, F(1, 49) = 5.32, p = .025. Significant relationships between emotion recognition and cognitive functions were found only in the MS group, namely for information processing speed (r = 0.59, p < .001), verbal learning (r = 0.52, p = .003) and memory (r = 0.65, p < 0.001), and visuospatial learning (r = 0.62, p < 0.001) and memory (r = 0.52, p = .003). Emotion recognition did not correlate with premorbid functioning, mood, or fatigue in either group. ConclusionsThis study was the first to employ the ACS-SP to assess emotion recognition in MS. The results suggest that emotion recognition is impacted in MS and is related to other cognitive processes, such as information processing speed. The results provide information for clinicians amidst calls to include social cognition measures in standard MS assessments.

Time to Diagnosis and Treatment Initiation During the COVID-19 Pandemic Among Rural Patients With Cancer.

Time to diagnosis (TTD) and treatment initiation (TTI) are important measures of access to and quality of cancer care. This study addressed the knowledge gap on the impact of the COVID-19 pandemic on TTD and TTI for rural cancer patients. Sixty-three cancer patients residing in rural areas of the state of Hawaii were surveyed in 2020 to 2021. Overall, 67.5% of participants reported TTD within one month of reporting symptoms to a health care provider. Mean TTI for the overall sample was 55.3 days, and among breast cancer patients, 57.9 days. Compared with pre-pandemic state registry data, mean TTI for the overall sample and breast cancer patients were significantly longer than the state registry null value of 40 days (P = .02 and P =.05, respectively). During the COVID-19 pandemic, cancer patients in rural Hawaii experienced substantial delays in TTI compared with pre-pandemic years.