Efectos de la COVID-19 en la calidad de la atención de los servicios de salud en Colombia: Revisión de literatura / Effects of COVID-19 on the quality of health care services in Colombia: a literature review / Efeitos da covid-19 na qualidade dos serviços de saúde na colômbia: revisão da literatura

Introducción: La pandemia por COVID-19 ha afectado significativamente la calidad de los servicios de cuidado de la salud. Objetivo: Analizar los efectos en los atributos de la calidad en salud de los servicios de atención de enfermedades diferentes a la COVID-19 en Colombia, durante el periodo 2020-2022. Materiales y métodos: Se analizaron 24 artículos de alcance nacional y otros específicos de departamentos como Antioquia, Córdoba, Santander y Cundinamarca. Resultados: La pandemia por COVID-19 impactó la calidad de los servicios en la atención de enfermedades como cáncer, accidentes cerebrovasculares y de eventos como la interrupción voluntaria del embarazo. Conclusión: La calidad de la salud se vio afectada en todas sus dimensiones durante las fases de la pandemia, especialmente en la población con enfermedades crónicas y relacionadas con la salud infantil y materna. Además, se destacaron respuestas como el uso de la telemedicina y de la atención domiciliaria para contribuir a la calidad de la salud en Colombia.

Introduction: The COVID-19 pandemic has significantly affected the quality of health care services. Objective: To analyze the effects of COVID-19 on the quality of health care services focused on treating diseases other than COVID-19 in Colombia during the 2020-2022 period. Materials and methods: 24 articles were analyzed, which included some studies focused on national issues and others specific to the departments of Antioquia, Cordoba, Santander, and Cundinamarca. Results: The COVID-19 pandemic affected the quality of health services caring for diseases such as cancer, strokes, and critical circumstances like voluntary termination of pregnancy. Conclusion: All dimensions of health care were affected during the pandemic, especially impacting populations with chronic diseases and diseases related to child and maternal health. It is important to highlight that telemedicine and home care contributed to improving the quality of health in Colombia.

Introdução: A pandemia de COVID-19 afetou significativamente a qualidade dos serviços de saúde. Objetivo: Analisar os efeitos da COVID-19 nos atributos de qualidade em saúde dos serviços de atenção a outras doenças além da COVID-19 na Colômbia, durante o período 2020-2022. Materiais e métodos: foram analisados 24 artigos de âmbito nacional e outros específicos de departamentos como Antioquia, Córdoba, Santander e Cundinamarca. Resultados: A pandemia da COVID-19 impactou a qualidade dos serviços no cuidado de doenças como câncer, acidente vascular cerebral e eventos como a interrupção voluntária da gravidez. Conclusão: A qualidade da saúde foi afetada em todas as suas dimensões durante as fases da pandemia, especialmente na população com doenças crônicas e doenças relacionadas à saúde infantil e materna. Além disso, foram destacadas respostas como o uso da telemedicina e do atendimento domiciliar para contribuir para a qualidade da saúde na Colômbia.

Cognitive, affective, and behavioral engagement with science news predicted by the use of accessibility strategies in science-minded and general audiences.

Numerous studies have explored internal factors such as cultural values and acquired knowledge accounting for how people engage with science. However, it remains unclear how external factors embedded in science texts relate to audience engagement. A content analysis of 298 text-based popular science news articles and their following 5852 reader comments was conducted in two Israeli audiences, science-minded and general readers, to explore how the accessibility strategies embedded in these articles relate to cognitive, affective, and behavioral engagement. Findings indicated similar patterns of relationship between accessibility strategies and engagement expressions for both audiences; however, the relationships were more pronounced for general readers compared to science-minded readers. Using jargon and a narrative writing style increased the odds of positive emotions in reader comments, whereas addressing socio-scientific issues increased the odds of cognitive expressions. These results may contribute to a fuller understanding of ways to drive meaningful public engagement.

Effect of cellulose reducing ends and primary hydroxyl groups modifications on cellulose-cellulase interactions and cellulose hydrolysis.

Cellulose reducing ends are believed to play a vital role in the cellulose recalcitrance to enzymatic conversion. However, their role in insoluble cellulose accessibility and hydrolysis is not clear. Thus, in this study, reducing ends of insoluble cellulose derived from various sources were modified by applying reducing and/or oxidizing agents. The effects of cellulose reducing ends modification on cellulose reducing ends, cellulose structure, and cellulose accessibility to cellulase were evaluated along with the impact on cellulose hydrolysis with complete as well purified cellulase components. Sodium borohydride (NaBH4) reduction and sodium chlorite-acetic acid (SC/AA) oxidation were able to modify more than 90% and 60% of the reducing ends, respectively, while the bicinchoninic acid (BCA) reagent applied for various cycles oxidized cellulose reducing ends to various extents. X-ray diffractograms of the treated solids showed that these treatments did not change the cellulose crystalline structure and the change in crystallinity index was insignificant. Surprisingly, it was found that the cellulose reducing ends modification, either through selective NaBH4 reduction or BCA oxidation, had a negligible impact on cellulose accessibility as well on cellulose hydrolysis rates or final conversions with complete cellulase at loadings as low as 0.5 mg protein/g cellulose. In fact, in contrast to what is traditionally believed, modifications of cellulose reducing ends by these two methods had no apparent impact on cellulose conversion with purified cellulase components and their synergy. However, SC/AA oxidation resulted in significant drop in cellulose conversion (10%-50%) with complete as well purified cellulase components. Nonetheless, further research revealed that the cause for drop in cellulose conversion for the SC/AA oxidation case was due to primary hydroxyl groups (PHGs) oxidation and not the oxidation of reducing ends. Furthermore, it was found that the PHGs modification affects cellulose accessibility and slows the cellulase uptake as well resulting in significant drop in cellulose conversions.

Associations of clinical personnel characteristics and telemedicine practices.

CONTEXT: The use of telemedicine strategies has been increasing in the United States for more than a decade, with physicians taking advantage of this new tool to reach more patients. Determining the specific demographics of physicians utilizing telemedicine most in their practice can inform recommendations for expanded telemedicine use among all physicians and aid in mitigating the need for local physicians in urban and rural populations. OBJECTIVES: This study aims to assess the use of telemedicine by physicians in 2021, based on four demographics utilizing the National Electronic Health Record Survey (NEHRS): physician age, sex, specialty, and training. METHODS: We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and telemedicine practices. Differences between groups were measured through design-based chi-square tests. RESULTS: Compared to male physicians, female physicians were more likely to utilize telemedicine services (X 2=8.0; p=0.005). Compared to younger physicians, those over the age of 50 were less likely to utilize telemedicine services (X 2=4.1; p=0.04). Compared to primary care physicians, medical and surgical specialty physicians were less likely to utilize telemedicine services, with surgical specialty physicians being the least likely overall (X 2=11.5; p<0.001). We found no significant differences in telemedicine use based on degree (Osteopathic and Allopathic). CONCLUSIONS: Our results showed a statistically significant difference between physician's age, sex, and specialty on telemedicine use in practice during 2021. Efforts to increase telemedicine use among physicians may be needed to provide more accessible care to patients. Thus, by increasing physician education on the importance of telemedicine for modern patients, more physicians may decide to utilize telemedicine services in practice.

"The genie is out of the bottle": a qualitative study on the impact of COVID-19 on continuing professional development.

BACKGROUND: The onset of the COVID-19 pandemic catalysed a monumental shift in the field of continuing professional development (CPD). Prior to this, the majority of CPD group-learning activities were offered in-person. However, the pandemic forced the field to quickly pivot towards more novel methods of learning and teaching in view of social distancing regulations. The purpose of this study was to obtain the perspectives of CPD leaders on the impact of the pandemic to elucidate trends, innovations, and potential future directions in the field. METHODS: Semi-structured interviews were conducted between April-September 2022 with 23 CPD leaders from Canada and the USA. Interviews were audio-recorded, transcribed, and de-identified. A thematic analysis approach was used to analyse the data and generate themes. RESULTS: Participants characterised COVID-19 as compelling widespread change in the field of CPD. From the interviews, researchers generated six themes pertaining to the impact of the pandemic on CPD: (1) necessity is the mother of innovation, (2) the paradox of flexibility and accessibility, (3) we're not going to unring the bell, (4) reimagining design and delivery, (5) creating an evaluative culture, and (6) a lifeline in times of turmoil. CONCLUSION: This qualitative study discusses the impact of the pandemic on the field of CPD and leaders' vision for the future. Despite innumerable challenges, the pandemic created opportunities to reform design and delivery. Our findings indicate a necessity to maintain an innovative culture to best support learners, to improve the healthcare system, and to prepare for future emergencies.

Infant Feeding Support for Pregnant and Postpartum Parents With Intellectual and Developmental Disabilities: Perspectives of WIC Staff.

OBJECTIVE: To describe the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) staff experiences, perceptions, and training needs surrounding the provision of infant feeding support for parents with intellectual and developmental disabilities (IDD). METHODS: We conducted in-depth semistructured interviews between October and November 2021 with Maryland WIC staff (N = 10) who provide infant feeding counseling and support. We analyzed interviews using conventional content analysis. RESULTS: Three themes were identified: identifying and documenting IDD, facilitating effective communication and infant feeding education, and assessing WIC staff competence and readiness. CONCLUSIONS AND IMPLICATIONS: The interviews suggested the need to explore the risks and benefits of routine and compassionate processes for identifying and documenting disability, create accessible teaching materials that facilitate understanding and engagement, and educate and train staff to provide tailored support in WIC. Engaging parents with IDD to better understand their perspectives and experiences should guide future efforts to improve inclusivity and accessibility.

Relationship between hukou conversion and psychological integration of rural older migrants: the mediating effect of accessibility to health resources.

OBJECTIVE: This study investigates the relationship between hukou conversion and the psychological integration of rural older migrants, exploring the mediating role of accessibility to health resources. METHODS: The 3,963 valid samples of rural older migrants included in the study were sourced from the 2017 China Migrants Dynamic Survey (CMDS). The study established a multiple linear regression model for estimation and utilized inverse probability-weighted regression adjustment (IPWRA) method to correct for the selection bias of hukou conversion. RESULTS: Compared to older migrants with rural hukou, merit-based (ß = 0.384, 95% CI: 0.265 to 0.504), family-based (ß = 0.371, 95% CI: 0.178 to 0.565) and policy-based (ß = 0.306, 95% CI: 0.124 to 0.487) converters have significantly higher psychological integration. These findings remain robust even after addressing the potential issue of endogenous selection bias using the IPWRA method. Bootstrap mediating effect tests indicate that hukou conversion can indirectly affect psychological integration through the mediator role of health resources accessibility. CONCLUSION: Accessibility of health resources mediates the association between hukou conversion and psychological integration. Policymakers should enhance the implementation of hukou conversion, strengthen the health resource guarantee system, and achieve a deeper psychological integration among rural older migrants.

Critical issue in the identification of Down syndrome and its problems in Central Java, Indonesia: The fact of needing health care and better management.

We conducted a cross-sectional study to describe the health care problems of children with Down syndrome in Central Java, Indonesia. A total of 162 children (81 boys, 81 girls) with Down syndrome were included. Congenital heart defects and hypothyroidism were found in about 50%, followed by vision and hearing problems in 27.7% and 17.3%, respectively. Almost half of cases were diagnosed after the first month of age. Advanced maternal age was identified in more than 50%, and less than 10% was based on karyotype analysis. This study describes the essential issues such as critical co-morbidities, delayed diagnosis, advanced maternal age, and lack of (accessibility to) genetic testing facilities; thus, better health care and management is needed.

Place-Based Differences in the Association Between Greenspace and Suicide-Related Outcomes Among Young People.

PURPOSE: This study investigated place-based differences in the association between greenspace and suicide-related outcomes (SROs) among young people, guided by the following two objectives: (1) Contextualize place-based differences in the association between greenspace and SRO prevalence among young people at the community level in five different urbanities (urban, suburban, micropolitan, small towns, and rural/isolated communities) and (2) identify which greenspace metrics (quantity, quality, or accessibility) are most protective for SROs at the community level. METHODS: Publicly available greenspace datasets were used to derive greenspace quantity, quality, and accessibility metrics. SRO emergency department visits for young people were identified from 2016-2019 in North Carolina, USA. Generalized linear models investigated the association between greenspace metrics and community-level drivers of SRO prevalence. Shapely additive explanations confirmed the most important greenspace variables in accurately predicting community-level SRO prevalence. RESULTS: The prevalence of SROs was highest in communities with the least amount of public greenspace; this association was most pronounced in suburban communities, with SROs 27% higher in suburban communities with low quantities of greenspace (PRRUrban: 1.11, confidence interval [CI]: 1.08-1.13; PRRSuburban: 1.27, CI: 1.10-1.46; PRRSmallTowns: 1.21, CI: 1.05-1.39), and in communities with the worst greenspace accessibility (i.e., furthest distance to nearest greenspace) (PRRUrban: 1.07, CI: 1.04-1.10; PRRRural&Isolated: 1.95, CI: 1.54-2.49). DISCUSSION: Our analysis provides place-based, community-specific findings to guide targeted greenspace interventions aimed at addressing the rising prevalence of SROs among young people. Our findings suggest that greenspace quantity interventions may be most effective in urban, suburban, and small-town communities, and greenspace accessibility interventions may be most useful in urban and rural/isolated communities.

"Being ill was the easy part": exploring cancer survivors' reactions to perceived challenges in engaging with primary healthcare.

PURPOSE: Cancer survivors experience barriers to primary healthcare (PHC) services. The aim was to explore reactions to and opinions about perceived challenges associated with PHC access and quality among cancer survivors in Sweden, including how they have acted to adapt to challenges. METHODS: Five semi-structured focus group interviews were conducted with cancer survivors (n = 20) from Skåne, Sweden, diagnosed with breast, prostate, lung, or colorectal cancer or malignant melanoma. Focus groups were mixed in regard to diagnosis. Data were analysed using a descriptive template analysis approach. RESULTS: In light of perceived challenges associated with access to adequate PHC, participants experienced that they had been forced to work hard to achieve functioning PHC contacts. The demands for self-sufficiency were associated with negative feelings such as loneliness and worry. Participants believed that cancer survivors who lack the ability to express themselves, or sufficient drive, risk missing out on necessary care due to the necessity of being an active patient. CONCLUSIONS: The findings highlight negative patient experiences. They have implications for the organization of care for cancer survivors as they indicate a need for more efficient post-treatment coordination between cancer specialist care and PHC providers, as well as increased support for patients leaving primary cancer treatment.

Demographic Disparities in Lung Cancer Mortality and Trends in the United States From 1999 Through 2020: A Population-Based CDC Database Analysis.

BACKGROUND: Lung cancer is the leading cause of cancer-related mortality in the United States and is projected to account for 127,070 deaths in 2023. Although the lung cancer mortality rate has been decreasing over the last decade, demographic disparities in mortality still exist. We sought to determine the impact of demographic factors on lung cancer mortality and trends in the United States. PATIENTS AND METHODS: We queried the Centers for Disease Control and Prevention (CDC) database for mortality statistics with an underlying cause of death of lung and bronchus cancer from 1999 through 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 people. We assessed the AAMR by demographic variables, including race, geographic density, sex, age, and US census region. Temporal trends were evaluated using Joinpoint regression software, and average annual percent change (APC) was calculated. RESULTS: From 1999 through 2020, lung cancer led to 3,380,830 deaths. The AAMR decreased by 55.1 to 31.8, with an associated average APC of -2.6%. In 1999, men had an AAMR almost twice as high as women, but these differences became less pronounced over time. Rural populations experienced the highest AAMR and the slowest rate of decrease compared with urban populations, who experienced the lowest AAMR and fastest decrease. Non-Hispanic Black individuals experienced the highest AAMR, with an annual decrease of -3.0%. The West experienced the fastest decrease at -3.1% annually, whereas the Midwest experienced the slowest decrease at -2.0% annually. CONCLUSIONS: Although the mortality rate of lung cancer has been decreasing since 1999, not all demographic groups have experienced the same rates of decrease, and disparities in outcomes are still prevalent. Vulnerable subgroups need targeted interventions, such as the incorporation of patient navigators, improved screening chest CT scan access and follow-up, and telehealth expansion, which will improve the likelihood of earlier-stage diagnoses and the potential for curative treatments.

Centering Digital Health Equity During Technology Innovation: Protocol for a Comprehensive Scoping Review of Evidence-Based Tools and Approaches.

BACKGROUND: In the rush to develop health technologies for the COVID-19 pandemic, the unintended consequence of digital health inequity or the inability of priority communities to access, use, and receive equal benefits from digital health technologies was not well examined. OBJECTIVE: This scoping review will examine tools and approaches that can be used during digital technology innovation to improve equitable inclusion of priority communities in the development of digital health technologies. The results from this study will provide actionable insights for professionals in health care, health informatics, digital health, and technology development to proactively center equity during innovation. METHODS: Based on the Arksey and O'Malley framework, this scoping review will consider priority communities' equitable involvement in digital technology innovation. Bibliographic databases in health, medicine, computing, and information sciences will be searched. Retrieved citations will be double screened against the inclusion and exclusion criteria using Covidence (Veritas Health Innovation). Data will be charted using a tailored extraction tool and mapped to a digital health innovation pathway defined by the Centre for eHealth Research roadmap for eHealth technologies. An accompanying narrative synthesis will describe the outcomes in relation to the review's objectives. RESULTS: This scoping review is currently in progress. The search of databases and other sources returned a total of 4868 records. After the initial screening of titles and abstracts, 426 studies are undergoing dual full-text review. We are aiming to complete the full-text review stage by May 30, 2024, data extraction in October 2024, and subsequent synthesis in December 2024. Funding was received on October 1, 2023, from the Centre for Health Equity Incubator Grant Scheme, University of Melbourne, Australia. CONCLUSIONS: This paper will identify and recommend a series of validated tools and approaches that can be used by health care stakeholders and IT developers to produce equitable digital health technology across the Centre for eHealth Research roadmap. Identified evidence gaps, possible implications, and further research will be discussed. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53855.

Opportunities for play in paediatric healthcare environments: a scoping review.

Play spaces are important components of paediatric healthcare environments. They provide children with critical opportunities to experience the social, emotional, and developmental benefits of play while in healthcare settings for appointments or hospitalizations. These spaces can help to mitigate stress, provide a sense of normalcy in unfamiliar environments, and facilitate social engagement for children and their families. Given the benefits of play spaces in paediatric healthcare settings, it is important to understand how these spaces can be designed to enhance children's inclusion and quality of care. The aim of this scoping review was to explore the current understanding of paediatric play space design. Using search terms related to children, health care, and play space, six interdisciplinary databases were searched over a 30-year period. The search found 2,533 records from which eighteen were included for review. Findings suggest that although it is well-documented that play spaces offer valuable social and emotional benefits, little is known about the specific design features that can and should be incorporated to enhance play opportunities and ensure that they benefit all children and families. Further, the literature mostly considers play spaces in the context of designated play or recreational rooms. Scholars are encouraged to consider how play opportunities can be incorporated into the designs of paediatric healthcare environments beyond the boundaries of these rooms. Future studies should also consider the diversity of play space users, including children of varying ages and abilities, to create more accessible and inclusive paediatric play spaces for children and their families. Advancing knowledge on play space design can help to optimize the quality of these important spaces and to ensure their designs meaningfully enhance children's play experiences and quality of care.

Consequences of geographical accessibility to post-exposure treatment for rabies and snakebite in Africa: a mini review.

Introduction: Rabies and snakebite envenoming are two zoonotic neglected tropical diseases (NTDs) transmitted to humans by animal bites, causing each year around 179,000 deaths and are most prevalent in Asia and Africa. Improving geographical accessibility to treatment is crucial in reducing the time from bite to treatment. This mini review aims to identify and synthesize recent studies on the consequences of distance and travel time on the victims of these diseases in African countries, in order to discuss potential joint approaches for health system strengthening targeting both diseases. Methods: A literature review was conducted separately for each disease using Pubmed, Google Scholar, and snowball searching. Eligible studies, published between 2017 and 2022, had to discuss any aspect linked to geographical accessibility to treatments for either disease in Africa. Results: Twenty-two articles (8 on snakebite and 14 on rabies) were eligible for data extraction. No study targeted both diseases. Identified consequences of low accessibility to treatment were classified into 6 categories: (1) Delay to treatment; (2) Outcome; (3) Financial impacts; (4) Under-reporting; (5) Compliance to treatment, and (6) Visits to traditional healers. Discussion and conclusion: Geographical access to treatment significantly influences the burden of rabies and snakebite in Africa. In line with WHO's call for integrating approaches among NTDs, there are opportunities to model disease hotspots, assess population coverage, and optimize geographic access to care for both diseases, possibly jointly. This could enhance the management of these NTDs and contribute to achieving the global snakebite and rabies roadmaps by 2030.

Association between the home-to-healthcare center distance and hearing aid abandonment among older adults.

Background: Access to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment. Objective: To assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system. Methods: 455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects. Results: Approximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04-1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity. Conclusion: A higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).

Geographic accessibility to physiotherapy care in Aotearoa New Zealand.

Disparities in care access for health conditions where physiotherapy can play a major role are abetting health inequities. Spatial analyses can contribute to illuminating inequities in health yet the geographic accessibility to physiotherapy care across New Zealand has not been examined. This population-based study evaluated the accessibility of the New Zealand physiotherapy workforce relative to the population at a local scale. The locations of 5,582 physiotherapists were geocoded and integrated with 2018 Census data to generate 'accessibility scores' for each Statistical Area 2 using the newer 3-step floating catchment area method. For examining the spatial distribution and mapping, accessibility scores were categorized into seven levels, centered around 0.5 SD above and below the mean. New Zealand has an above-average physiotherapy-to-population ratio compared with other OECD countries; however, this workforce is maldistributed. This study identified areas (and locations) where geographic accessibility to physiotherapy care is relatively low.

Spatial accessibility and inequality analysis of rabies-exposed patients to rabies post-exposure prophylaxis clinics in Guangzhou City, China.

BACKGROUND: The incidence of rabies exposure is high and increasing in China, leading to an urgent demand of rabies post-exposure prophylaxis (PEP) clinics for the injured. However, the spatial accessibility and inequality of rabies-exposed patients to rabies PEP clinics is less known in China. METHODS: Based on rabies exposure data, PEP clinic data, and resident travel origin-destination (OD) matrix data in Guangzhou City, China, we first described the incidence of rabies exposure in Guangzhou from 2020 to 2022. Then, the Gaussian two-step floating catchment area method (2SFCA) was used to analyze the spatial accessibility of rabies-exposed patients to rabies PEP clinics in Guangzhou, and the Gini coefficient and Moran's I statistics were utilized to evaluate the inequality and clustering of accessibility scores. RESULTS: From 2020 to 2022, a total of 524,160 cases of rabies exposure were reported in Guangzhou, and the incidence showed a significant increasing trend, with an average annual incidence of 932.0/100,000. Spatial accessibility analysis revealed that the overall spatial accessibility scores for three scenarios (threshold of driving duration [d0] = 30 min, 45 min, and 60 min) were 0.30 (95% CI: 0.07, 0.87), 0.28 (95% CI: 0.11, 0.53) and 0.28 (95% CI: 0.14, 0.44), respectively. Conghua, Huangpu, Zengcheng and Nansha districts had the higher accessibility scores, while Haizhu, Liwan, and Yuexiu districts exhibited lower spatial accessibility scores. The Gini coefficient and Moran's I statistics showed that there were certain inequality and clustering in the accessibility to rabies PEP clinics in Guangzhou. CONCLUSIONS: This study clarifies the heterogeneity of spatial accessibility to rabies PEP clinics, and provide valuable insights for resource allocation to achieve the WHO target of zero human dog-mediated rabies deaths by 2030.

NucMap 2.0: an updated database of genome-wide nucleosome positioning map across species.

Nucleosome dynamics plays important roles in many biological processes, such as DNA replication and gene expression. NucMap (https://ngdc.cncb.ac.cn/nucmap) is the first database of genome-wide nucleosome positioning map across species. Here, we present an updated version, NucMap 2.0, by incorporating more species and MNase-seq samples. In addition, we integrate other related omics data for each MNase-seq sample to provide a comprehensive view of nucleosome positioning, such as gene expression, transcription factor binding sites, histone modifications and DNA methylation. In particular, NucMap 2.0 integrates and pre-analyzes RNA-seq data and ChIP-seq data of human-related samples, which facilitates the interpretation of nucleosome positioning in humans. All processed data are integrated into an in-built genome browser, and users can make comprehensive side-by-side analyses. In addition, more online analytical functions are developed, which allows researchers to identify differential nucleosome regions and explore potential gene regulatory regions. All resources are open access with a user-friendly web interface.

Survival of biomass and waste power generation: A global overview.

Biomass and waste power generation holds the promise to secure electricity supply for a growing population and mitigate global warming simultaneously. Along with the increasing commission and installation of biomass/waste power units (BWPUs) across the globe, some BWPUs failures have been observed, including the cancellation of planned/commissioned BWPUs and the termination of those in operation before reaching their natural retirement. While empirical evidence suggests that factors like feedstock accessibility and policy instruments might affect the feasibility and performance of BWPUs, there is a lack of comprehensive investigation about why some BWPUs failed at the global scale. To fill this knowledge gap, this study quantifies the hazard ratio of BWPUs via a parametric survival analysis using a panel dataset covering a total of 12,829 BWPUs (relying on woody, non-woody, and waste biomass as raw feedstocks) located in 164 countries/regions worldwide for the period of 2001-2021. The analytical results suggest that large unit size is conducive to BWPUs failure, while feedstock accessibility and the implementation of policy instruments (including Feed-in-Tariff and carbon pricing) could largely reduce the hazard ratio of BWPUs, with varying impacts on BWPUs at the planned/commissioned stage or the operation stage, located in developed or developing countries. Our findings not only shed additional light on the fate of BWPUs, which is crucial to enriching our understanding about the development of the bioenergy sector worldwide, but also provide salient empirical evidence for policy-making in terms of ensuring feedstock accessibility, overcoming diseconomies of scale, and making fiscal instruments available and transparent to boost the confidence of investors and entrepreneurs in support of BWPUs development.

Equity in the Setting of Heart Failure Diagnosis: An Analysis of Differences Between and Within Clinician Practices.

BACKGROUND: Timely heart failure (HF) diagnosis can lead to earlier intervention and reduced morbidity. Among historically marginalized patients, new-onset HF diagnosis is more likely to occur in acute care settings (emergency department or inpatient hospitalization) than outpatient settings. Whether inequity within outpatient clinician practices affects diagnosis settings is unknown. METHODS: We determined the setting of incident HF diagnosis among Medicare fee-for-service beneficiaries between 2013 and 2017. We identified sociodemographic and medical characteristics associated with HF diagnosis in the acute care setting. Within each outpatient clinician practice, we compared acute care diagnosis rates across sociodemographic characteristics: female versus male sex, non-Hispanic White versus other racial and ethnic groups, and dual Medicare-Medicaid eligible (a surrogate for low income) versus nondual-eligible patients. Based on within-practice differences in acute diagnosis rates, we stratified clinician practices by equity (high, intermediate, and low) and compared clinician practice characteristics. RESULTS: Among 315 439 Medicare patients with incident HF, 173 121 (54.9%) were first diagnosed in acute care settings. Higher adjusted acute care diagnosis rates were associated with female sex (6.4% [95% CI, 6.1%-6.8%]), American Indian (3.6% [95% CI, 1.1%-6.1%]) race, and dual eligibility (4.1% [95% CI, 3.7%-4.5%]). These differences persisted within clinician practices. With clinician practice adjustment, dual-eligible patients had a 4.9% (95% CI, 4.5%-5.4%) greater acute care diagnosis rate than nondual-eligible patients. Clinician practices with greater equity across dual eligibility also had greater equity across sex and race and ethnicity and were more likely to be composed of predominantly primary care clinicians. CONCLUSIONS: Differences in HF diagnosis rates in the acute care setting between and within clinician practices highlight an opportunity to improve equity in diagnosing historically marginalized patients.