Distribution Utilities Research Articles

Derivation and Initial Validation of the Utility Function for the Hearing Utility Measure (HUM).

The Hearing Utility Measure (HUM) is a replacement hearing attribute for the Health Utilities Index, Mark 3 (HUI-3) designed to improve the responsiveness of utility estimates to changes in hearing-related quality of life. The final development step is to derive the instrument's utility scoring function. Residents of Ontario, Canada, aged ≥18 years participated in standard gamble and visual analogue scale exercises. Valuations for levels (response options) within each domain, and for each domain relative to the other domains were elicited and used to generate a hearing utility function. The function outputs hearing utility ranging from 0 = 'unable to hear at all' to 1 = 'perfect hearing' for each of the 25,920 hearing states classifiable by the HUM. Performance was assessed relative to the criterion standard: directly elicited standard gamble utility. Distributions of HUM-derived hearing utility were compared with legacy HUI-3 derived estimates. A total of 126 respondents participated (mean age 39.2, range 18-85 years, 53% female [67/126]). The utility function performed well in the estimation of directly elicited utilities (mean difference 0.03, RMSE 0.06). Using the legacy HUI-3, estimated hearing utility was 1.0 for 118/126 respondents (93.6%) compared with just 66/126 (52.4%) using the HUM. The new hearing attribute is capable of measuring variations in hearing utility not captured by the legacy HUI-3, especially near the ceiling of hearing function. These findings justify its application and further work to study its measurement properties in hearing loss populations. 3 Laryngoscope, 134:4754-4762, 2024.

A General Concave Fairness Framework for Influence Maximization Based on Poverty Reward

Influence maximization (IM) aims to find a group of influential nodes as initial spreaders to maximize the influence spread over a network. Yet, traditional IM algorithms have not been designed with fairness in mind, resulting in discrimination against some groups, like LGBTQ communities and racial minorities, etc. This issue has spurred research on Fair Influence Maximization (FIM). However, existing FIM studies come with some drawbacks. Firstly, most proposed notions of fairness for FIM cannot adjust the trade-off between fairness level and influence spread. Secondly, though a few specific notions of fairness allow such balancing, they are limited to a few specific concave functions, which may not be suitable for various real-world scenarios. Furthermore, none of them have studied the deep relations between the features of concave functions and the level of fairness. Thirdly, existing fairness metrics are limited to their corresponding concepts of fairness. Comparing the level of fairness across different algorithms using existing metrics can be challenging. To tackle the above problems, this paper first proposes a novel fairness notion named Poverty Reward (PR), which achieves fairness by rewarding the enrichment of groups with low utility. Based on PR, we further propose an algorithmic framework called Concave Fairness Framework (CFF) that allows any concave function that satisfies specific requirements. We also systematically clarify how fairness is improved by applying concave functions and provide an in-depth quantitative analysis of how to select appropriate concave functions for different utility distributions. Moreover, we propose the Reward of Fairness (RoF) metric that evaluates the disparity between groups. Based on RoF, an evaluation system is built to uniformly compare FIM algorithms from different fairness notions. Experiments in real-world datasets have demonstrated the validity of the CFF, as well as the proposed fairness notion.

Trends in Phototherapy Utilization, Payments, and Geographic Distribution: An Analysis of United States Medicare Part B From 2000 to 2021.

Trends in phototherapy utilization in the context of new therapeutics have not been evaluated. This study aimed to evaluate phototherapy utilization, payments, and geographic distribution for Medicare beneficiaries from 2000 to 2021. A longitudinal analysis of the Medicare Part B National Summary Data Files was conducted to obtain phototherapy utilization and payment amounts. Medicare Physician & Other Practitioners by Provider and Service datasets were used to determine provider type and geographic distribution. Between 2000 and 2021, total Medicare phototherapy volume increased from 335,152 to 621,850, correlating with a 3.0% annual growth rate (5.0% between 2000 and 2015, -3.1% between 2016 and 2021). Ultraviolet B phototherapy represented the majority of use, rising from 68.1% in 2000 to 78.0% in 2021. Psoralens plus ultraviolet A decreased by 11.3% annually, while laser treatments increased by 17.3%. Between 2013 and 2021, the number of clinics offering phototherapy declined; facilities were available in only 9.9% of counties, mainly clustered along both coasts and east of the Mississippi. Overall, phototherapy continues to be an important therapeutic option. Limited access in non-urban areas remains a significant challenge, and further work is necessary to both evaluate this impact and reduce disparities.

Plasmonic chitosan cross-linked dialdehyde chitosan aerogels as 3D surface-enhanced Raman scattering substrates for sensitive and reliable detection

Surface Enhanced Raman Scattering (SERS) has the advantages of non-destructive detection and high sensitivity, however, low hotspots utilisation and inhomogeneous distribution limit its application. In response to the problem of underutilization of hotspots in most SERS substrates, a crosslinking of chitosan with dialdehyde chitosan aerogels loaded with Ag NPs (CDSA) as SERS substrates with chitosan (CS) as the main body and dialdehyde chitosan (DACS) as the reducing and cross-linking agent were prepared. Unlike other 3D structures such as hydrogels, CDSA can capture probe molecules in a much shorter period of time and enhance SERS signals by collapse. The SERS performance of CDSA was evaluated by rhodamine 6 G (R6G) and methylene blue (MB), indicating that the CDSA substrate has good stability (90 days), repeatability (RSD=4.15 %) and reproducibility (RSD=4.86 %). The enhancement factors (EFs) was 1.3×108 for R6G and 9.2×107 for MB. Both gas sample and liquid sample were detected to evaluate the performances of CDSA in practical application. 4-Aminothiophenol (4-ATP) was utilized to test the efficacy of CDSA on gas-phase to-be-tested substances and the limit of detection (LOD) was 0.59 mg/L. The tests performed on sildenafil (SD) in real samples showed recoveries ranging from 97.5 % to 103.4 % with a LOD of 0.055 mg/L. It was indicated that the CDSA substrate could serves as a satisfactory SERS sensor for sensitive and rapid detection for both gas phase and liquid samples.

Utility-Scale Grid-Connected Microgrid Planning Framework for Sustainable Renewable Energy Integration

Microgrids have emerged as a crucial focus in power engineering and sustainable energy research, with utility-scale microgrids playing a significant role in both developed and developing countries like the Philippines. This study presents a comprehensive framework for utility-scale microgrid planning, emphasizing the sustainable integration of renewable energy resources to the distribution grid. The framework addresses the operational modes of grid-connected and islanded microgrids, emphasizing the seamless transition between these modes to ensure a continuous power supply. By leveraging local distributed energy resources, the microgrid aims to reduce dependence on the main transmission grid while enhancing resilience and reliability. The proposed planning framework not only eases the economic burden of constructing renewable energy sources but also aids distribution utilities in maximizing local resources to achieve sustainable energy goals. Through a detailed network analysis and modeling, the framework provides a robust foundation for optimizing the energy mix and enhancing the overall system performance. This research contributes to advancing microgrid technology as a key driver towards achieving UN Sustainable Development Goals, particularly in promoting clean and affordable energy access.

Health utilities of patients with epilepsy in a Canadian population.

Health state utilities are required to obtain quality adjusted life years, a common metric that informs clinical decision-making at individual, group, and health policy levels. Health state utilities are different from health-related quality of life, and their distribution across patients with epilepsy, as well as the factors that impact them, have not been studied in depth. We aimed to describe the distribution of health state utilities in people with epilepsy and the impact of different combinations of clinical and demographic factors on health state evaluation. We performed a retrospective analysis of patients' data prospectively collected in the Calgary Comprehensive Epilepsy Program registry. Patient-reported health state utilities were measured using the 5-level EuroQol 5-Dimension scale (EQ-5D-5L) completed at their initial assessment. EQ-5D-5L index scores were derived via the time trade-off approach based on Canadian norms, and their distribution across different health states and patient characteristics was obtained. The Tobit regression model was used to evaluate the determinants of EQ-5D-5L index scores. Of 1446 patients included in this analysis, 724 (50.5%) were female. The median (interquartile range) Canada-normed EQ-5D-5L index score was .87 (.71-.91). Patients with significantly lower health utilities were more likely to be female (p = .008), to be older (p = .034), to be unmarried (p = .013), to have failed to achieve 1-year seizure freedom (p < .001), to have no postsecondary education (p = .028), to be depressed (p < .001), to have antiseizure medication side effects (p = .001), to be unemployed (p < .001), and to be unable to drive (p < .001). A look-up table of health utilities based on combinations of clinical-demographic characteristics was produced. Health utility estimates for combinations of different health states in people with epilepsy attending specialty clinics are now available. These can help guide clinical decision-making in routine clinical practice, economic evaluations of treatment interventions, and health care policies.

Construction of honeycomb-like N-doped porous carbon framework with effective aperture distribution toward advanced supercapacitors and sodium-ion batteries

Smart synthesis of porous carbon with appropriate aperture distribution and high area utilization still retains an enormous challenge for efficient charge storage. Herein, a simple freeze-drying along with subsequent one-step carbonization/activation process is ingeniously devised to fabricate honeycomb-like nitrogen-doped porous carbon (NPC) framework with high-level active N/O-functional groups and hierarchical porous structure including substantial ultra-micropores (<0.7 nm). The underlying formation mechanism of such porous NPC framework is tentatively proposed. By finely regulating the dosage of NaHCO3, the optimized NPC (i.e., NPC114) is endowed with ultra-high surface area utilization of ∼26.4 μF cm−2 at 1 A/g in KOH electrolyte, which is close to theoretical value of electrochemical double-layer capacitance (15–25 μF cm−2), and even larger than the case (∼22.4 μF cm−2) with H2SO4 electrolyte due to the inaccessible ultra-micropores by SO42− of larger size. Similarly, as for the organic system, the as-prepared NPC115 with higher meso- and macropore surface area exhibits higher energy density of 22.36 Wh kg−1 than other counterparts. Furthermore, NPC114, when evaluated as anode material for sodium-ion batteries, exhibited more attractive high-rate Na+-storage properties as well. The in-depth understanding into intrinsic relationship between aperture distribution and electrochemical behaviors will provide meaningful guidance for electrode material design

A methodology for preliminary benefit evaluation of Distributed Generation to drive private investments

Private investments in distributed generation (DG) are typically driven by the interests of private investor, often overlooking possible benefits for the distribution operator. This work presents a methodology that enables power distribution utilities to assess the potential for attracting investments in their networks, considering a regulatory framework where utilities could actively encourage private DG investors. The methodology involves calculating and integrating the benefits associated with investment deferral, losses reduction and reliability improvement into the energy price negotiated between the utility and the DG owner. The proposed approach was applied to an adapted test grid, considering real regulatory aspects related to technical losses and reliability. The results provide support for utilities to perform preliminary financial analyses to determine the appropriate incentives for private DG investors, identifying cases with competitive energy prices for generators. Key contributions of this methodology include a clear and reasonable metric for quantifying the capacity to attract investments based on standard utility data and the importance of incorporating regulatory aspects related to technical losses and reliability, that are often neglected in similar studies. Furthermore, the methodology not only promotes new opportunities for DG investors but also addresses challenges associated with network congestion.

Examining the role of virtual teams on project management processes in the Nigerian fintech sector

This study examined the role of virtual teams on project management processes in the Nigerian fintech industry. To achieve this aim, the study sought to examine how communication technology utilisation, trust, and geographical distribution of team members affected the project management processes of virtual team members in the Nigerian fintech industry. Building upon the theoretical frameworks of social presence theory and transaction cost theory, the study adopted a quantitative approach and used a sample of 385 employees of fintech firms in Nigeria. Using an electronic close-ended questionnaire (Google forms), data were collected from 378 participants, indicating a response rate of 98.2%. Purposive sampling technique was used to select the study’s participants. Data were analysed using both descriptive (frequencies and percentages) and inferential statistics (multiple linear regression) via the aid of STATA 17. Findings from the study revealed that communication technology utilization (β = 0.3114694, p &lt; 0.05) and geographical distribution of team members (β =0.7622249, p &lt; 0.05) both had statistically significant effects on project management processes. Trust was found to have an insignificant effect on project management processes (β = -0.0085031, p &gt; 0.798). The study concluded that virtual teams significantly and positively affects project management processes in the Nigerian fintech industry, and recommends that firms in the industry should continue with the use of virtual teams in their given projects. Also, the study recommends that policies regarding work in the virtual environment should be formalised so as to maximise the benefits associated with virtual work.

Adjusting for quality of care in primary health care utilization and benefits in Bihar, India: A Benefit Incidence Analysis

India’s public health policies prioritize the least wealthy and vulnerable. Additionally, for Primary Health Care (PHC) to achieve equitable health outcomes, all must receive high-quality care. This study determined equality of utilization and benefit incidence of PHC services across socioeconomic (SE) groups in Bihar, with and without adjusting for quality of care. It used secondary data from linked PHC facility and household surveys in Bihar that included information on PHC facility utilization, quality of care and household expenditure patterns. Lorenz curves and concentration indices were constructed to examine relative distribution of utilization and benefits from public sector PHC services by SE status, before and after adjusting for quality of care using quality weights. We found that relative distribution of public sector PHC utilization, total and net benefits was statistically no different from perfect equality. With quality weights, utilization and benefits of PHC facilities in Bihar were slightly more pro-rich but statistically no different from perfect equality. The wealthiest do not disproportionately benefit from public sector PHC facilities, but neither do the least wealthy.In conclusion, relative utilization and benefits of public sector PHC facilities were equally distributed across socioeconomic groups in Bihar. Benefits from public sector PHC facilities are not disproportionately concentrated among the least wealthy in the community. As the Ayushman-Bharat Health and Wellness Centers are strengthened to improve public sector PHC services, it would be important to target its benefits towards the least wealthy by ensuring services are accessible and amenable.

Healthcare Utilization and Geographic Distribution of Advanced Therapy in Minority Race and Ethnic Groups With Inflammatory Bowel Disease.

Biases in healthcare pose challenges for inflammatory bowel disease (IBD) patients from underrepresented races and ethnicities. Our study aimed to assess the quality of and access to care among underrepresented racial and ethnic populations using a diverse database. We used the OneFlorida Data Trust, representing over half of Florida's population. We performed a retrospective study from 2012 to 2020. Advanced IBD therapies included a prescription of at least 1 biologic agent or tofacitinib. Disease activity markers included C-reactive protein (CRP), hemoglobin (Hgb), albumin, and white blood cell (WBC). Regression analyses compared the rates of medication use, healthcare utilization, and disease severity by race and ethnicity. Geographic distribution of advanced IBD therapy was analyzed at the county level. Our study included 10 578 patients. Hispanic patients utilized more biologics than non-Hispanic White (NHW) patients (odds ratio [OR]: 1.3, P<.0001). Non-Hispanic Black patients utilized more steroids than NHW (OR: 1.2, P=.0004). Hispanics had fewer visits to emergency departments (EDs) and fewer admissions compared with NHW (OR: 0.7 and 0.6, respectively; P<.0001). Non-Hispanic Black patients visited ED more frequently than NHW patients (OR: 1.3, P<.0001). Hispanics had lower disease activity markers than NHW based on CRP (OR: 0.5, P=.005), Hgb (OR: 0.4, P<.0001), albumin (OR: 0.7, P<.0001), and WBC (OR: 0.5, P<.0001). Geographic distribution of advanced IBD therapy showed clustered areas in southern and northern Florida. Our data show an improved access to care pattern in Hispanic patients. However, disparities still exist, and this is evident in the healthcare utilization trends observed among non-Hispanic Black patients.

Day-ahead dynamic operating envelopes using stochastic unbalanced optimal power flow

Driven by the energy transition, distribution networks are dealing with increasing uptake of distributed energy resources, including solar photovoltaic generation. Residential rooftop solar allows customers to minimize exposure to price increases in the market, which has led to high penetration of PV in regions with high amounts of solar hours such as Australia. Eventually, this leads to congestion in the network, either due to voltage rise, or due to overcurrent in lines or transformers. Distribution utilities are now moving on from static export limits for customers in congested networks, to dynamic limits that are based on the state of the network. It is considered thoughtful to give customers advance warning, e.g. day-ahead, of the moments and degrees of export limitation, despite uncertainty surrounding the future state of the network. Therefore, in this paper, we consider the application of general polynomial chaos expansion based stochastic unbalanced optimal power flow to the day-ahead determination of dynamic export limits. We perform a numerical study on a European style low voltage feeder and illustrate the impact of fairness principles on chance-constrained stochastic nonlinear optimization without the need of sampling, linearizing the power flow equations, or applying relaxations. Case studies show the necessity of considering unbalanced study of distribution system. It was observed that equality measures reduce the overall output of the system in an attempt to achieve equal relative injection, while alpha fairness with a higher value of alpha is a compromise between the efficiency and fairness in DOEs.

Revolutionizing MANET Route Discovery with INTSM: An Innovative Load Balancing Approach

Communication challenges in ad hoc networks arise due to the mobility of nodes, causing frequent changes in connections and locations. Maintaining network equilibrium to prevent node overload and underutilization is crucial. However, imposing static behaviors on nodes to improve performance can lead to delays, especially in core nodes. Addressing these issues, this research proposes the Intermediate Node Traffic Sharing Model (INTSM) for ad hoc networks. INTSM prioritizes congestion control and load balancing during route discovery, aiming to optimize network resource utilization and traffic distribution, thereby reducing packet delays. The model employs dynamic traffic sharing algorithms that consider real-time network conditions, enabling nodes to adjust their behaviour adaptively. This approach minimizes congestion by distributing traffic loads more evenly across the network, preventing bottlenecks at central nodes. Additionally, INTSM incorporates predictive analysis to foresee potential congestion points and reroute traffic proactively, enhancing overall network stability and performance. Extensive simulations demonstrate that INTSM significantly reduces average packet delay and improves throughput compared to traditional routing protocols. The results highlight the model&amp;apos;s efficacy in diverse scenarios, including high mobility and varying traffic loads, proving its robustness and scalability. The primary objective of this study is to enhance navigation and equilibrium mechanisms to improve the performance of ad hoc networks, contributing to more reliable and efficient wireless communication systems. The findings of this research have significant implications for the design of future ad hoc networks, particularly in applications requiring high reliability and quick adaptation to changing network conditions, such as disaster recovery, military operations, and mobile sensor networks. By addressing the critical challenges of congestion control and load balancing, INTSM offers a promising solution to enhance the resilience and efficiency of ad hoc networks.

Quantization of two- and three-player cooperative games based on QRA

Abstract In this paper, a novel quantization scheme for cooperative games is proposed. The circuit is inspired by the Eisert-Wilkens-Lewenstein protocol, which was modified to represent cooperation between players and extended to 3--qubit states. The framework of Clifford algebra is used to perform necessary computations. In particular, we use a direct analogy between Dirac formalism and Quantum Register Algebra to represent circuits. This analogy enables us to perform automated proofs of the circuit equivalence in a simple fashion. The expected value of the Shapley value concerning quantum probabilities is employed to distribute players' payoffs after the measurement. We study how entanglement, representing the level of pre-agreement between players, affects the final utility distribution. The paper also demonstrates how the Quantum Register Algebra and GAALOP software can automate all necessary calculations.

Movements, foraging and habitat selection of southern stingrays (Hypanus americanus) in a tropical ecosystem altered by an invasive seagrass

This study provides some of the first evidence of how a common Caribbean fish species that relies on seagrass and sand habitats interacts with an invasive seagrass. The invasive seagrass Halophila stipulacea, first documented in the Caribbean in 2002, has rapidly expanded its range, displacing native seagrasses, and overgrowing bare sand. The southern stingray (Hypanus americanus) uses shallow seagrass and sand habitats for foraging. This paper examined the impacts of the invasive seagrass, H. stipulacea, on southern stingray behavior, foraging and movement patterns using acoustic telemetry and visual observations. From 2015 to 2018, 15 southern stingrays (14 juveniles of unknown sex and 1 female) were tagged with acoustic transmitters and passively monitored within an acoustic array in Brewers and Perseverance Bays, St. Thomas, United States Virgin Islands. The residence time, rates of movement and activity spaces for 50% and 95% utilization distributions (UD) were calculated for day and night periods. Tagged southern stingrays were detected within the array on average for 260 d (range 11–801 d) and residency for all individuals averaged 53% over the monitoring period (1079 d). Mean rates of movement per individual ranged from 40 to 150 m h−1, was lowest during the nighttime and were significantly higher during crepuscular periods. Activity spaces during day and night periods were nearly identical and averaged 0.05 km2 and 0.25 km2 for 50% and 95% UD, respectively. Distances between day and night 50% UD activity spaces was 148 m (range 8–409 m) and mean percent overlap was 38%. In addition to acoustic monitoring, benthic cover of available habitats and visual surveys of stingray behavior and habitat preferences were conducted along fixed transects. Monotypic stands of the invasive H. stipulacea seagrass represented 42% of benthic cover, followed by bare sand (27%), mixed patches of native and invasive seagrasses (23%) and the native Syringodium filiforme (7%). A habitat selection index (HSI) comparing the percent cover of available habitats and habitats occupied by stingrays found a strong preference for the native seagrass S. filiforme (HSI = 2.30) and bare sand (HSI = 1.79) compared to H. stipulacea (HSI = 0.70). Visual surveys also revealed that 50% of foraging stingrays were in S. filiforme, while 28% and 17% were foraging in H. stipulacea and bare sand, respectively. Our results are an important baseline for examining how further expansion of H. stipulacea may affect southern stingray movement patterns and foraging preferences.

456 Allocating distribution of pasture utilization across the grazing landscape in grazing steers equipped with virtual fencing collars

Abstract Spatial utilization of pasture landscapes by grazing animals is often heterogeneous and driven by complex environmental and physiological interactions between plants and animals. Synergistic energy pathways can be modeled using mechanistic relationships describing resource distribution, animal behavior, metabolic energy rate, and pasture utilization using biometric sensors. The objective of this study was to demonstrate the ability to measure the energy landscape by mapping fine-scale contributions to animal energy expenditure, nutrient acquisition, growth, and overall economic profitability. We utilized animal trajectories and location fixes recorded by virtual fencing collars (Vence) daily body weight (BW) using precision livestock scales (Smartscale, C-Lock Inc.) and oxygen consumption (GreenFeeds, C-Lock Inc.) on steers (n = 127), managed as part of a broader project to evaluate environmental synergies in extensive grazing systems. Steers were allocated to one of six native grass pastures assigned to either rotational or continuous grazing strategies, and one of three stocking rates (low, moderate, high) in a 2 x 3 factorial arrangement. Space utilization was quantified as the frequency of fixes located within each cell of a 5 x 5-meter Grid and the distance between grid cells and water was calculated using the Pythagorean theorem. Movement behavior was quantified using Program R to calculate step length, the distance between two temporally continuous fix points utilizing the Pythagorean Theorem, and turn angles calculated as the cosine of the pre- and pro-ceeding step lengths where larger values indicated greater deviation from a straight trajectory. A mixed linear regression model was fitted using the lmer function in the lme4 package. Space utilization decreased with increased distance from water (P &amp;lt; 0.05), with rotational grazing strategies increasing concentration around water sources (P &amp;lt; 0.05). This indicates an opportunity to utilize precision livestock technology to facilitate pasture management and increase space utilization in grazing cattle.

Creating a population-wide Desirable Health Service Utilisation Indicator using linked health and administrative data

Background and ObjectiveHealthcare research faces challenges in developing metrics that resonate with the general public or policymakers. We created a Desirable Health Service Utilisation Indicator (DHSUI) to address this gap, centred around New Year’s wishes for survival and non-occurrence of undesired events in the following year, for the population of Wales, UK, following discussions with policy-makers. MethodsWe accessed and linked individual electronic healthcare records from primary and secondary care sources within the Secure Anonymised Information Linkage (SAIL) Databank. The study used data for all Welsh General Practice registered individuals on the 1st January 2015 with follow-up until residency break, death, or 31st December 2022. The DHSUI was calculated per person per year and quantified the distribution of the population who survive calendar years and do not use selected health services (not admitted to hospital; no emergency department attendance; and not prescribed antibiotics, analgesics, or mental health drugs). We linked area level demographic data to measure socio-economic differences in DHSUI distribution. ResultsFocussing on 2022, a population of 2,668,977 people were included, with 1,150,347 (43%) identified as meeting the indicator. The proportion of desirable health decreased significantly with age and with increasing socio-economic deprivation. A higher proportion of males (50%) had desirable health compared to females (37%). The most prevalent sub-indicator among those with undesirable health was antibiotic prescriptions accounting for 52% of cases. ConclusionThis DHSUI indicator is easy to interpret and will assist policymakers and the public in understanding the magnitude and distribution of desirable healthcare utilisation.

Investigating an Asymmetric Ratio Cosine Distribution

Most real-world data have asymmetric features, slight or pronounced, that cannot be analyzed in depth using classical symmetric distributions. This is especially true when the underlying phenomena take their values in bounded support. Examples include data with support (−1, 1), which may correspond to daily temperature anomalies, stock market returns and satisfaction ratings, among others. Motivated by this last point, this article introduces a novel asymmetric cosine distribution of the ratio type. It aims to extend the functionalities of the classical cosine distribution by incorporating two adjustable parameters that allow for flexible levels of asymmetry. The main functions and theoretical properties such as moments, quantiles and distributional properties are studied. Some derived distributions are also established, extending the scope of the Cauchy and half-Cauchy distributions. Applications to simulated data in hypothetical environmental, financial and sentiment analysis scenarios demonstrate the practical utility of the asymmetric cosine distribution in capturing nuanced behavior.

SP6.14 - The Burden of Penetrating Junctional Injuries in a UK Major Trauma Centre: a Retrospective Cohort Study

Abstract Background Junctional injuries occur at the join of ‘anatomically distinct zones’. The emergence of junctional injuries in trauma care has been a consequence of recent battlefield casualties; accounting for 21% of potentially survivable deaths from haemorrhage. Although well described in military literature, there are no civilian studies into junctional injuries. This study aims to examine the epidemiology and resource burden of junctional penetrating injuries. Methods Retrospective study of adult and paediatric patients with penetrating injuries to a junctional zone presenting to an urban MTC in one year. Electronic patient records were searched and data on anatomical distribution of injury, imaging and theatre utilisation, inpatient stay, and discharge codes extracted. Discharge codes were referenced with the National Schedule of NHS costs to produce a cost. Results In 132 patients 92.4% (n=122) were male with median age 27.5 and in hospital mortality 1.6% (n=2). Saturday and Sunday were most frequent 37.9% (n=50) and 81.8% (n=108) attended after 1700 and before 0800. 37.9% (n=50) of injuries were buttock; 22% (n=29) neck; 18.9% (n=25) multiply-injured; 8.3% (n=11) axilla; 6.8% (n=9) diaphragm; and 6.1% (n=8) groin. Median Injury Severity Score (ISS) 8. 46.2% (n=61) underwent surgery; 50.8% (n=67) were admitted, 7.6% (n=10) to ITU. Median length of ward stay was 3 days. 15.9% (n=21) received blood products. The overall cost was £914,076. Conclusion Junctional injuries are a significant resource burden. Buttock wounds were the most common but had the lowest median ISS and cost. Diaphragmatic injuries appear distinct from junctional wounds in terms of ISS and cost, and may be separate to other junctional zones.

Prevalence, spatial distribution and determinants of complete childhood pneumococcal conjugate vaccination in Ethiopia: spatial and multilevel analyses

IntroductionPneumococcal disease is a serious global public health concern. The primary causative agent of severe illnesses such as pneumonia, meningitis, acute otitis media, and bacteremia is the pneumococcus bacterium. The pneumococcal conjugate vaccine is a key strategy to reduce the burden of pneumococcal disease. Understanding the spatial distribution of complete childhood pneumococcal conjugate vaccine utilization and its associated factors is crucial for designing strategies to improve vaccination implementation. Therefore, this study aimed to determine the spatial distribution of complete childhood pneumococcal conjugate vaccination coverage and identify its determinants in Ethiopia.MethodA spatial and multilevel analysis was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey. The analysis included a total of 2,055 weighted children. The association between the outcome variable and the explanatory variables was determined by calculating adjusted odds ratios at a 95% confidence interval. Explanatory variables were considered significantly associated with the outcome if the p-value was less than 0.05.ResultThe prevalence of complete childhood pneumococcal conjugate vaccination in Ethiopia was 53.94% (95% CI: 51.77, 56.08). Higher complete childhood pneumococcal vaccination coverage was observed in the Addis Ababa, Tigray, Amhara, Benishangul-Gumuz, and Oromia regions, while lower coverage was seen in the Afar, Somali, and SNNPR regions of Ethiopia. Factors significantly associated with complete childhood pneumococcal conjugate vaccination included maternal age, antenatal care visits, place of delivery, region, community women’s literacy level, community poverty level, and community antenatal care utilization.ConclusionThe distribution of complete childhood pneumococcal conjugate vaccination exhibited spatial variability across Ethiopia. Approximately half of children aged twelve to thirty-five months received the full dose of the childhood pneumococcal conjugate vaccine in the country. Several factors were identified as statistically significant determinants of complete childhood pneumococcal conjugate vaccination, including maternal age, antenatal care visits, place of delivery, region, community women’s literacy level, community poverty level, and community ANC utilization. Therefore, policies and strategies aimed at combating pneumococcal disease should consider these determinants and address areas with low vaccination coverage.