RESUMO
Socio-economic factors could impact how epidemics spread. In this study, we investigated the possible effect of several local socio-economic factors on the case count and time course of confirmed Covid-19 cases and Covid-19-related deaths across the twenty one counties of New Jersey. Socio-economic and geographic factors considered included population, percentage of elders in the population, percentage of low-income households, access to food and health facilities and distance to New York. We found that the counties could be clustered into three groups based on (a) the case totals, (b) the total number of deaths, (c) the time course of the cases and (d) the time course of the deaths. The four groupings were very similar to one another and could all be largely explained by the county population, the percentage of low-income population, and the distance of the county from New York. As for food and health factors, the numbers of local restaurants and pharmacies significantly influenced the total number of cases and deaths as well as the epidemic's evolution. In particular, the number of cases and deaths showed a decrease with the number of McDonald's within the county in contrast to other fast-food or non-fast food restaurants. Overall, our study found that the evolution of the epidemic was influenced by certain socio-economic factors, which could be helpful for the formulation of public health policies.
RESUMO
Importance: The current program-centric algorithm for the National Resident Matching Program (NRMP) primarily uses the program's ranking of students to determine a match. Concerns that the existing algorithm favors programs over students, recent findings that the program's ranking of applicants is not associated with resident performance, and disruptions of existing screening methods and metrics have prompted reevaluation of the current algorithm relative to a student-centric algorithm, in which student ranking of programs is primary and program ranking of students is secondary. Objective: To compare program-centric and student-centric algorithms for the NRMP participants. Design, Setting, and Participants: This cross-sectional study used randomized computer-generated data reflecting the NRMP match for 2018, 2019, and 2020, capturing more than 50â¯000 students and more than 4000 programs in 23 specialties, to compare the 2 algorithms. Exposures: The same simulated students, programs, and rankings were exposed to the 2 algorithms, running 2300 simulations in the overall analysis and 1000 simulations in each of 23 specialties. Main Outcomes and Measures: The percentage of students who did and did not match, the percentage of students who matched to their top-ranked and top-5-ranked programs, and the program's rank of the last student matched per position were examined. Results: The 2 algorithms were not different in percentage of students matched overall (eg, for 2020, program-centric: 59% [95% CI, 57%-61%]; student-centric: 58% [95% CI, 56%-60%]; P = .73). The student-centric algorithm, relative to the program-centric algorithm, matched a significantly higher percentage of students to their first-ranked program (eg, for 2020, 50% [95% CI, 48%-52%] vs 14% [95% CI, 13%-15%]; P < .001) and to their top-5-ranked programs (eg, for 2020, 60% [95% CI, 58%-62%] vs 46% [95% CI, 44%-48%]; P < .001). However, the last position was filled with students who had lower program rankings in the student-centric algorithm vs the program-centric algorithm (2 [95% CI, 1-2] vs 8 [95% CI, 6-10]; P < .001). Conclusions and Relevance: In this study, the 2 algorithms were not different in the percentage of students matched overall. However, the student-centric algorithm matched a significantly higher percentage of students to their preferred programs. The program-centric algorithm was associated with a lower program's last matched student rank. Further research is needed on the algorithms' associations with cost and time demands in the match, postmatch resident and program performance, and fit with a changing environment.
