Importance: Patients often travel for cancer care, yet the extent to which patients cross state lines for cancer care is not well understood. This knowledge can have implications for policies that regulate telehealth access to out-of-state clinicians.
Objective: To quantify the extent of cross-state delivery of cancer services to patients with cancer.
This study employs an innovative multi-constraint Monte Carlo simulation method to estimate suppressed county-level cancer counts for population subgroups and extend the downscaling from county to ZIP Code Tabulation Areas (ZCTA) in the U.S. Given the known cancer counts at a higher geographic level and larger demographic groups at the same geographic level as constraints, this method uses the population structure as probability in the Monte Carlo simulation process to estimate suppressed data entries.
View Article and Find Full Text PDFPurpose: Oncology outreach is a common strategy for extending cancer care to rural patients. However, a nationwide characterization of the traveling workforce that enables this outreach is lacking, and the extent to which outreach reduces travel burden for rural patients is unknown.
Methods: This cross-sectional study analyzed a rural (nonurban) subset of a 100% fee-for-service sample of 355,139 Medicare beneficiaries with incident breast, colorectal, and lung cancers.
The complicated task of evaluating potential telehealth access begins with the metrics and supporting datasets that seek toevaluate the presence and durability of broadband connections in a community. Broadband download/upload speeds are one of the popular metrics used to measure potential telehealth access, which is critical to health equity. An understanding of the limitations of these measures is important for drawing conclusions about the reality of the digital divide in telehealth access.
View Article and Find Full Text PDFEquity in health care delivery is a longstanding concern of public health policy. Telehealth is considered an important way to level the playing field by broadening health services access and improving quality of care and health outcomes. This study refines the recently developed "2-Step Virtual Catchment Area (2SVCA) method" to assess the telehealth accessibility of primary care in the Baton Rouge Metropolitan Statistical Area, Louisiana.
View Article and Find Full Text PDFTelehealth has been widely employed and has transformed how healthcare is delivered in the United States as a result of COVID-19 pandemic. While telehealth is utilized and encouraged to reduce the cost and travel burden for access to healthcare, there are debates on whether telehealth can promote equity in healthcare services by narrowing the gap among diverse groups. Using the Two-Step Floating Catchment Area (2SFCA) and Two-Step Virtual Catchment Area (2SVCA) methods, this study compares the disparities of physical and virtual access to primary care physicians (PCPs) in Louisiana.
View Article and Find Full Text PDFUnlabelled: Defining a reliable geographic unit pertaining to cancer care is essential in its assessment, planning, and management. This study aims to delineate and characterize the cancer service areas (CSA) accounting for the presence of major cancer centers in the United States. We used the Medicare enrollment and claims from January 1, 2014 to September 30, 2015 to build a spatial network from patients with cancer to cancer care facilities that provided inpatient and outpatient care of cancer-directed surgery, chemotherapy, and radiation.
View Article and Find Full Text PDFThe combustion characteristics of premixed methane-air flames in a half-open tube with a two-sided 45° branch structure at different ignition positions were investigated by experiments and large eddy simulations. The numerical results were compared with the experimental results to verify the correctness of the model. The results show that the simulation results are highly consistent with the experiment.
View Article and Find Full Text PDFSpat Spatiotemporal Epidemiol
November 2022
The purpose of delineating Cancer Service Areas (CSAs) is to define a reliable unit of analysis, more meaningful than geopolitical units such as states and counties, for examining geographic variations of the cancer care markets using geographic information systems (GIS). This study aims to provide a multiscale analysis of the U.S.
View Article and Find Full Text PDFEnviron Plan B Urban Anal City Sci
November 2022
The COVID-19 pandemic has exerted unprecedented impacts on the world. Since its onset, China has established a network of fever clinics as an effective strategy to aggressively isolate and screen possible patients with COVID-19 symptoms. This study presents two fever clinic maps that visualize the uneven responses to the COVID-19 pandemic at the city level in mainland China.
View Article and Find Full Text PDFSince the Dartmouth hospital service areas (HSAs) were proposed three decades ago, there has been a large body of work using the unit in examining the geographic variation in health care in the U.S. for evaluating health care system performance and informing health policy.
View Article and Find Full Text PDFPurpose: Geographic access to cancer care is known to significantly impact utilization and outcomes. Longer travel times have negative impacts for patients requiring highly specialized care, such as for rare cancers, and for those in rural areas. Scant population-based research informs geographic access to care for rare cancers and whether rurality impacts that access.
View Article and Find Full Text PDFIn this paper, the effects of different ignition positions and equivalence ratios on the explosion characteristics of syngas in a half-open Hele-Shaw duct were investigated. The ignition points are set at distances of 0 and 500 mm from the closed end. Moreover, the research range of equivalence ratio is 0.
View Article and Find Full Text PDFBackground: Delays between breast cancer diagnosis and surgery are associated with worsened survival. Delays are more common in urban-residing patients, although factors specific to surgical delays among rural and urban patients are not well understood.
Methods: We used a 100% sample of fee-for-service Medicare claims during 2007-2014 to identify 238,491 women diagnosed with early-stage breast cancer undergoing initial surgery and assessed whether they experienced biopsy-to-surgery intervals > 90 days.
Garbage and biomass contain more chlorine, which reacts with H to form HCl gas during combustion or gasification, resulting in corrosion of metal walls. In this paper, based on the chlorine mechanism in Ansys Chemkin-Pro, the laminar combustion characteristics of H/Cl are simulated with different diluents CO/N under an initial temperature of 298 K, equivalence ratio range of 0.6-1.
View Article and Find Full Text PDFConstructing service areas is an important task for evaluating geographic variation of health care markets. This study uses cancer care as an example to illustrate the methodology, with the nine-state Northeast Region of the U.S.
View Article and Find Full Text PDFThe COVID-19 (coronavirus disease 2019) pandemic has expanded telehealth utilization in unprecedented ways and has important implications for measuring geographic access to healthcare services. Established measures of geographic access to care have focused on the spatial impedance of patients in seeking health care that pertains to specific transportation modes and do not account for the underlying broadband network that supports telemedicine and e-health. To be able to measure the impact of telehealth on healthcare access, we created a pilot augmentation of existing methods to incorporate measures of broadband accessibility to measure geographic access to telehealth.
View Article and Find Full Text PDFPurpose: Spatial behavior of patients in utilizing health care reflects their travel burden or mobility, accessibility for medical service, and subsequently outcomes from treatment. This paper derives the best-fitting distance decay function to capture the spatial behaviors of cancer patients in the Northeast region of the U.S.
View Article and Find Full Text PDFGreen space serves urban residents in various functions including promoting health, but the roles of different types of green space are unclear. A survey titled "Healthy Neighborhood" was conducted in Beijing from May to July 2019 to examine and compare the associations between three types of perceived green space (park green, public-square green and utility green) and three aspects of residents' health (physical health, mental health and social health). Results from the multilevel modeling (MLM) analysis show that the perceived park green has a positive correlation with mental health, and all three types of perceived green space correlate with social health positively.
View Article and Find Full Text PDFUneven distributions of population and service providers lead to geographic disparity in access for residents and varying workload for staff in facilities. The former can be captured by spatial accessibility in the traditional two-step floating catchment area (2SFCA) method; and the latter can be measured by potential crowdedness in the newly developed inverted 2SFCA (or i2SFCA) method. Residents-based accessibility and facility crowdedness are two sides of the same coin in examining the geographic variability of resource allocation.
View Article and Find Full Text PDFThe composition of low calorific value synthesis gas varies greatly depending on the raw material and processing technology, which makes the combustion extremely complicated. The three mechanisms of the GRI-Mech 3.0, Li-Model, and FFCM-Mech are used to numerically simulate CH/CO/H/N air premixed combustion by using ANSYS CHEMKIN-PRO.
View Article and Find Full Text PDFIn this paper, the flame propagation characteristics and overpressure oscillation characteristics of CH explosion were studied under different ignition positions (IPs) and oxygen enrichment conditions in a half-open tube. The distances between the IP and the closed end of the tube are 0, 250, 500, and 750 mm. The oxygen enrichment coefficient (φ) values used in the experiment are 0.
View Article and Find Full Text PDFThe propagation of premix methane/air flames in long half-open ducts with different inclination angles θ between the sidewall and the horizon was numerically investigated using the laminar model. The numerical result was compared with the experimental and theoretical ones to validate the numerical model. The results show that the numerical results are in good agreement with them.
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