Significant Reduction In Distance Research Articles

Reducing the travel burden for patients to access specialized medicines in Paraná, Brazil

This study aimed to evaluate the potential reduction in distance and travel time with a hypothetical municipal distribution of specialized component medicines in the state of Paraná. This was a cross-sectional study. Distances and travel times from all the 1025 residential locations in the state of Paraná to dispensing pharmacies were calculated in 2 different models: centralized model with drugs dispensed in the 22 state-owned pharmacies and decentralized model with drugs dispensed in the 399 municipal pharmacies. Road routes were calculated using the Google Maps Distance Matrix API and Euclidean distance using the haversine formula for the southern hemisphere. A sinuosity index was computed by the quotient between these 2 distances. Differences were evaluated through bivariate analyses and effect size measures were reported. In the centralized model, the mean distance to the pharmacy was 59.5 km (SD 34.1), with a travel time of 1.0 hour (SD 0.5) and 579 residential locations (56.7%) more than 50 km away from the pharmacy, 286 (28.0%) between 25 and 50 km, and 156 (15.3%) less than 25 km. In the decentralized model, the mean distance was 10.8 km (SD 16.6), with a travel time of 0.2 hours (SD 0.3) and 14 locations (1.4%) more than 50 km away from the pharmacy, 96 (9.4%) between 25 and 50 km, and 911 (89.2%) less than 25 km. The decentralized model significantly reduced the sinuosity index. Implementing a decentralized dispensing of the specialized component drugs in the state of Paraná would produce a significant reduction in distance and travel time for patients enhancing drug accessibility.

Building trauma capability: using geospatial analysis to consider military treatment facilities for trauma center development

BackgroundThe Military Health System must develop and sustain experienced surgical trauma teams while facing decreased surgical volumes both during and between deployments. Military trauma resources may enhance local trauma systems...

Percutaneous Coronary Sinus-Based Mitral Valve Repair Differentially Modulates Coronary Sinus to Mitral Valve Annulus Geometry and Topography

Objectives: Coronary sinus (CS) based mitral annuloplasty using the Carillon device is a therapeutic option for the treatment of functional mitral valve regurgitation (FMR).Background: Little is known about the change of CS and mitral valve annulus (MVA) planes following Carillon implantation and how they are modulated by the tension applied on the device.Methods: In a retrospective single-center analysis, 10 patients underwent Carillon device implantation and received CT-angiography (CTA) prior and post CS based percutaneous mitral valve repair. Patients were assigned to responders or non-responders according to the 3-month transthoracic echocardiographic follow-up. A prototype software was used to assess distance and angulation of both CS (pre) or Carillon-device (post) and mitral annulus planes.Results: Comparison of the distance and angulation of the CS plane or Carillon device plane and the MVA plane prior and post intervention showed significant reduction of distance and unchanged angulation in responders while angulation was increased and distance reduced in non-responders without statistical significance. Furthermore, in FMR responders MVA perimeter, anterior-posterior diameter, intercommisural diameter and MVA area were decreased following successful indirect mitral valve annuloplasty, while in FMR non-responders Carillon device implantation had no effect on MVA geometry.Conclusions: Insufficient reduction of FMR following indirect mitral valve annuloplasty is associated with device malposition in relation to the mitral valve annulus. Patient selection using CTA-derived distance and angulation of CS to MVA planes is one option to increase effectiveness of indirect mitral valve annuloplasty.

China’s Belt and Road Initiative

The Belt and Road initiative announced by China’s President Xi Jinping has introduced a novel economic model that seeks to shift the site and purpose of development outside China. The initiative proposes the construction of a series of transportation platforms along the ancient Silk Road that connected China with Central Asia, Europe and West Asia. This outward thrust of investment and capital construction envisages significant reduction of distance and in spatial barriers between and China and the world that will form the road traversing different geographies of nations, territories and cultures. I call China’s Belt and Road initiative a transnational development model as it aims to coordinate factors of economic circulation across different national spaces controlled by different governance models, legal norms and political contingencies. Centuries ago when the original trading route of the Chinese Silk Road was formed, this overland route was a contiguous territory where boundaries remained too fluid for any authorities to impose its will. But today the Silk Road is an imagined geography as this route is controlled by sovereign national territorial states having effective authority structures over each of these units. The initiative then requires China to entail a broad-based economic coordination with a diverse governance systems. My paper will explore how the transnational scope of the Belt and Road initiative come to negotiate diverse authority structures in particular national contexts.

Urban e-Grocery Distribution Design in Pamplona (Spain) Applying an Agent-Based Simulation Model with Horizontal Cooperation Scenarios

E-commerce has boosted in the last decades because of the achievements of the information and telecommunications technology along with the changes in the society life-style. More recently, the groceries online purchase (or e-grocery), has also prevailed as a way of making the weekly shopping, particularly, the one including fresh vegetables and fruit. Furthermore, this type of virtual shopping in supermarkets is gaining importance as the most efficient delivery system in cost and time. Thus, we have evaluated in this study the influence of the cooperation-based policies on costs and service quality among different supermarkets in Pamplona, Spain. Concerning methodology, first of all, we carried out a survey in Pamplona having the purpose of modelling the demand patterns about e-grocery. Second, we have developed an agent-based simulation model for generating scenarios in non-cooperative, limited cooperation, and full cooperation settings, considering the real data obtained from the survey analysis. At this manner, Vehicle Routing Problems (VRP) and Multi Depot VRPs (MDVRP) are dynamically generated and solved within the simulation framework using a biased-randomization algorithm. Finally, the results show significant reductions in distance driven and lead times when employing horizontal cooperation in e-grocery distribution.

Morphometric Measurements of Cervical Spine using Computed Tomography

The cervical spine antomy exhibits wide variations. For cervical spine pathologies which require surgical treatment, the prior knowledge of these anatomic variations would reduce the surgical complications. The aim of the study is to perform CT based measurements of cervical transverse foramen and spinal canal in indian population which would be useful in providing road map and guidance for surgical interventions of cervical spine. This is a retrospective study. A total of 73 patients (49 males, 24 females, age range: 18-75 years) indicated for CT cervical spine from June 2018 to June 2019 were included. The sagittal spinal canal Diameter (dSSC), sagittal (TFs) and transversr diameters (TFt) of transverse foramen, distance between transverse foramen and spinal canal (dTF-SC) were measured at C1-C7 levels. We found that significant difference in sagittal spinal canal diameters at all the levels of cervical spine (C1-C7) between males and females (p<0.01). Our study also found significant difference in sagittal (TFs) and transverse (TFs) diameters of transverse foramen at all cervical levels in males and females between right and left side (p<0.01). Significant difference were noted for distance between transverse foramen and spinal canal (dTF SC) at all the levels of cervical spine in males and females between right and left side (p<0.01). From our study we conclude that a thorough comprehension of cervical anatomy with CT- based measurements help in preoperative planning and reduce the complications in surgical interventions. Our study noticed significant reduction in distance between transverse foramen and spinal canal (dTF-SC) in both males and females on left side. Hence, care must be taken while performing surgical procedures of cervical spine on the left side in males and females at all cervical levels.

Socijalna distanca većinske populacije prema slepim osobama pre tri decenije i danas

Social distance is operationalized as the willingness of respondents to accept or reject a particular social relationship with members of the target group. Comparison of available empirical findings on the social distance towards the blind at several points of time did not lead to unambiguous conclusions. Therefore, we fully repeated the research from 1983. The aim was to determine the changes in the order of questions in the scale and the differences in social distance toward the blind for the complete scale and each of the items in the studies conducted in 1983 and 2016. In both studies the same modified Bogardus scale was used in a quota sample of adults. The results show that the closest social relationships (marriage and intimate relationships) are still at the top of the scale. Several items in the scale have changed ranking significantly (superiors at work, sharing hotel rooms, killing blind-born children). Values of the Chi-square test showed that there are significant differences in the complete scale and in the following relations: sharing hotel rooms (significantly increased distance), child marriage, child education, help in the street, municipality councilor, superiors at work, living in special institutions (significant reduction in distance). Qualitative analysis showed that the motivational basis for accepting and rejecting relationships with blind persons is less irrational today than three decades ago. Although smaller social distance in the recent study can partly be attributed to a lower degree of aggressiveness of respondents compared to that from the previous study, the fact that the explanations of answers today are far more rational than three decades ago shows that positive changes have actually occurred.

Influence of one- or two-stage methods for polymerizing complete dentures on adaptation and teeth movements

Abstract Introduction The quality of complete dentures might be influenced by the method of confection. Objective To evaluate the influence of two different methods of processing muco-supported complete dentures on their adaptation and teeth movements. Material and method Denture confection was assigned in two groups (n=10) for upper and lower arches according to polymerization method: 1) conventional one-stage - a wax trial base was made, teeth were arranged and polymerized; 2) two-stage method - the base was waxed and first polymerized. With the denture base polymerized, the teeth were arranged and then, performed the final polymerization. Teeth movements were evaluated in the distances between incisive (I-I), pre-molars (P-P), molars (M-M), left incisor to left molar (LI-LM) and right incisor to right molar (RI-RM). For the adaptation analysis, dentures were cut in three different positions: (A) distal face of canines, (B) mesial face of the first molars, and (C) distal face of second molars. Result Denture bases have shown a significant better adaptation when polymerized in the one-stage procedure for both the upper (p=0.000) and the lower (p=0.000) arches, with region A presenting significant better adaptation than region C. In the upper arch, significant reduction in the distance between I-I was observed in the one-stage technique, while the two-stage technique promoted significant reduction in the RI-RM distance. In the lower arch, one-stage technique promoted significant reduction in the distance for RI-RM and two-stage promoted significant reduction in the LI-LM distance. Conclusion Conventional one-stage method presented the better results for denture adaptation. Both fabrication methods presented some alteration in teeth movements.

Physical and decision-making demands of Australian football umpires during competitive matches.

This study examined the physical and decision-making requirements of elite Australian football (AF) umpires during match play. Twenty-nine field umpires were assessed across 20 AF League matches. Physical demands were monitored using global positioning system devices to record the total distance covered and high-speed running (HSR; >14.4 km·h) demands across each quarter. Decision-making performance was assessed through video by 3 elite umpire coaches who reviewed free-kick accuracy during each match. These data were further analyzed according to the position (mid-zone or end-zone) of the umpire when each decision was made. The average distance covered was 10,563 ± 608 m, of which 1,952 ± 494 m was HSR. Significant reductions in distance covered were observed during the third (p = 0.006) and fourth (p = 0.001) quarters, compared with the first. An average of 44 ± 8 free kicks awarded per match with a decision accuracy of 84 ± 6%; however, there were no significant differences (p > 0.05) in these measures across a match. Significantly (p ≤ 0.05) higher physical (HSR; relative distance) and decision-making requirements were observed within the mid-zone. The current data quantify the physical and decision-making demands of AF umpiring and demonstrated that despite a high physical workload, free-kick accuracy is maintained across a match. This suggests that decision making may not be directly compromised by the intermittent running demands of AF umpires. Positional rotations between the mid-zone and end-zone position allow for the demands to be shared among all field umpires during a match.

Effect of long-term physical activity practice after cardiac rehabilitation on some risk factors

The objective of this study was to evaluate the effects of long-term physical activity practice after a cardiac rehabilitation program on weight, physical capacity and arterial compliance. The Dijon Physical Activity Score was used to identify two groups: sedentary and active. Weight, distance at the 6-min walk test and the small artery elasticity indice were measured at the beginning, at the end of the rehabilitation program and at 18.3 ± 5.3 months after. After the cardiac rehabilitation, sedentary patients showed a significant increase in weight and a significant reduction in distance on the 6-min walk test and in the arterial compliance. Active patients did not show any alteration in these parameters. We concluded that, after a cardiac rehabilitation program, the sedentary lifestyle has a negative influence on weight, physical capacity and arterial compliance, which are major markers of risk factors. In contrast, the practice of physical activity preserves these parameters.

Effects of Trypanosoma cruzi infection on myocardial morphology, single cardiomyocyte contractile function and exercise tolerance in rats

The aim of this study was to investigate the effects of Trypanosoma cruzi (T. cruzi) infection on myocardial morphology, single cardiomyocyte contractile function and exercise tolerance in rats. Adult Wistar rats were randomized into control (n = 14) and infected (n = 14) groups. Infected animals were inoculated with T. cruzi Y strain (300,000 trypomastigotes/50 g body weight). After 9 weeks, the animals were subjected to a treadmill running protocol. Then, the right atrium (RA) and left ventricle (LV) were removed for morphological and cell contractile evaluation. The infected animals exhibited a significant reduction in distance travelled, total time to fatigue and workload. In addition, these animals had hypertrophy, increased myocardial cellularity, and an increase in the proportion of collagen and blood vessels. RA and LV myocytes from infected animals showed marked contractile dysfunction under basal conditions and a reduced contractile response to β-adrenergic stimulation. The workload of infected animals was correlated closely with the amplitude of cell shortening of RA and LV myocytes. T. cruzi infection influenced the myocardial morphology and the mechanical properties of RA and LV single myocytes negatively and reduced exercise tolerance. Single cardiomyocyte contractile dysfunction could constitute an additional mechanism of cardiac impairment and reduced exercise tolerance in this infection.

219. Parkin co-regulated gene (Pacrg) is an axonemal protein involved in sperm tail and ependymal cell function and is a candidate primary ciliary dyskinesia gene

A leading cause of male infertility is genetic variation in genes required for sperm formation or function. Considerable evidence suggests PACRG is involved in spermiogeneis. The loss of Pacrg function causes infertility in mice (Lorenzetti et al. 2004) and we have shown an association between variability in the 5′ untranslated region of PACRG and human male infertility (Wilson et al. in preparation). Evidence from studies in C.reinhardtii and T.brucei indicate Pacrg is crucial for axonome formation and microtubule stability. To assess this possibility in mammals, we generated and characterised Pacrg knockout (Quaking viable, Qkv), wildtype and Pacrg transgenic mice (Qkv-Tg). Using confocal and immunoelectron microscopy we showed that Pacrg was localised to the axonemal microtubule doublets of sperm, tracheal and ependymal cilia. The absence of Pacrg was associated with compromised sperm flagella formation and MRI analyses revealed the occurrence of hydrocephalus. Specifically, Qkv mice showed an inward expansion of the lateral ventricles, resulting in a significant reduction in distance between ventricles (1.0 ± 0.6 mm, mean ± s.d., n = 5) and a ~250% increase in ventricle area (70 ± 13 arbitrary units, mean ± s.d., n = 5) compared with wildtype littermates (1.38 ± 0.09 mm; area 26 ± 12, n = 3). Transgenic expression of Pacrg was necessary and sufficient to correct the hydrocephalus (1.45 ± 0.05 mm; area 26 ± 9, n = 2) and infertility phenotypes (evidenced by daily sperm counts and litter sizes). In conclusion, we have shown Pacrg is a novel axoneme associated protein in a subset of motile cilia/flagella and loss of Pacrg function results in spermiogenic defects and hydrocephalus in mice. Further, we have shown that variations in the human PACRG promoter are a risk factor in human male infertility. Collectively these data suggest PACRG is a candidate gene in the human syndrome of primary ciliary dyskinesia. (1) Lorenzetti D, Bishop CE, Justice MJ. 2004. Deletion of the Parkin coregulated gene causes male sterility in the quaking (viable) mouse mutant. Proc Natl Acad Sci U S A 101(22):8402–8407

One-Year Outcomes and Health Care Utilization in Survivors of Severe Acute Respiratory Syndrome

Severe Acute Respiratory Syndrome (SARS) became a global epidemic in 2003. Comprehensive information on 1-year outcomes and health care utilization is lacking. Research conducted during the SARS outbreak may help inform research planning for future public health emergencies. The objective of this study was to evaluate the 1-year outcomes in survivors of SARS and their family caregivers. The study was prospective and observational. We evaluated 117 SARS survivors from Toronto, Ontario. Patients were interviewed and underwent physical examination, pulmonary function testing, chest radiography, a 6-minute-walk test, quality-of-life measures, and self-report of health care utilization. At 1 year, informal caregivers were identified for a survey on caregiver burden. The enrolled survivors of SARS were young (median age, 42 years), and most were women (67%) and health care workers (65%). At 1 year after hospital discharge, pulmonary function measures were in the normal range, but 18% of patients had a significant reduction in distance walked in 6 minutes. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) domains were 0.3 to 1.0 SD below normal at 1 year. Of the patients, 17% had not returned to work by 1 year. Fifty-one patients required 668 visits to psychiatry or psychology practitioners. During the SARS epidemic, informal caregivers reported a decline of 1.6 SD below normal on the mental component score of the SF-36. Most SARS survivors had good physical recovery from their illness, but some patients and their caregivers reported a significant reduction in mental health 1 year later. Strategies to ameliorate the psychological burden of an epidemic on the patient and family caregiver should be considered as part of future pandemic planning.

Stem wood properties of Populus tremuloides, Betula papyrifera and Acer saccharum saplings after 3 years of treatments to elevated carbon dioxide and ozone

AbstractThe aim of this study was to examine the effects of elevated carbon dioxide [CO2] and ozone [O3] and their interaction on wood chemistry and anatomy of five clones of 3‐year‐old trembling aspen (Populus tremuloides Michx.). Wood chemistry was studied also on paper birch (Betula papyrifera Marsh.) and sugar maple (Acer saccharum Marsh.) seedling‐origin saplings of the same age. Material for the study was collected from the Aspen Free‐Air CO2 Enrichment (FACE) experiment in Rhinelander, WI, USA, where the saplings had been exposed to four treatments: control (C; ambient CO2, ambient O3), elevated CO2 (560 ppm during daylight hours), elevated O3 (1.5 × ambient during daylight hours) and their combination (CO2+O3) for three growing seasons (1998–2000). Wood chemistry responses to the elevated CO2 and O3 treatments differed between species. Aspen was most responsive, while maple was the least responsive of the three tree species. Aspen genotype affected the responses of wood chemistry and, to some extent, wood structure to the treatments. The lignin concentration increased under elevated O3 in four clones of aspen and in birch. However, elevated CO2 ameliorated the effect. In two aspen clones, nitrogen in wood samples decreased under combined exposure to CO2 and O3. Soluble sugar concentration in one aspen clone and starch concentration in two clones were increased by elevated CO2. In aspen wood, α‐cellulose concentration changed under elevated CO2, decreasing under ambient O3 and slightly increasing under elevated O3. Hemicellulose concentration in birch was decreased by elevated CO2 and increased by elevated O3. In aspen, elevated O3 induced statistically significant reductions in distance from the pith to the bark and vessel lumen diameter, as well as increased wall thickness and wall percentage, and in one clone, decreased fibre lumen diameter. Our results show that juvenile wood properties of broadleaves, depending on species and genotype, were altered by atmospheric gas concentrations predicted for the year 2050 and that CO2 ameliorates some adverse effects of elevated O3 on wood chemistry.