Background The Gambia has one of the lowest survival rates for breast cancer in Africa. Contributing factors are late presentation, delays within the healthcare system, and decreased availability of resources. We aimed to characterize the capacity and geographic location of healthcare facilities in the country and calculate the proportion of the population with access to breast cancer care. Methods A facility-based assessment tool was administered to secondary and tertiary healthcare facilities and private medical centers and clinics in The Gambia. GPS coordinates were obtained, and proximity of service availability and population analysis were performed. Distance thresholds of 10, 20, and 45 km were chosen to determine access to screening, pathologic diagnosis, and surgical management. An additional population analysis was performed to observe the potential impact of targeted development of resources for breast cancer care. Results All 102 secondary and tertiary healthcare facilities and private medical centers and clinics in The Gambia were included. Breast cancer screening is mainly performed through clinical breast examination and is available in 52 facilities. Seven facilities provide pathologic diagnosis and surgical management of breast cancer. The proportion of the Gambian population with access to screening, pathologic diagnosis, and surgical management is 72, 53, and 62%, respectively. A hypothetical targeted expansion of resources would increase the covered population to 95, 62, and 84%. Conclusions Almost half of the Gambian population does not have access to pathologic diagnosis and surgical management of breast cancer within the distance threshold utilized in the study. Mapping and population analysis can identify areas for targeted development of resources to increase access to breast cancer care.
ObjectivesDefine the services available for the care of breast cancer at hospitals in the Eastern Region of Ghana, identify areas of the region with limited access to care through geospatial mapping, and test a novel survey instrument in anticipation of a nationwide scale up of the study.DesignA cross-sectional, facility-based survey study.SettingThis study was conducted at 33 of the 34 hospitals in the Eastern Region of Ghana from March 2020 to May 2020.ParticipantsThe 33 hospitals surveyed represented 97% of all hospitals in the region. This included private, government, quasi-government and faith-based organisation owned hospitals.ResultsSixteen hospitals (82%) surveyed provided basic screening services, 11 (33%) provided pathological diagnosis and 3 (9%) provided those services in addition to basic surgical care.53%, 64% and 78% of the population lived within 10 km, 25 km and 45 km of screening, diagnostic and treatment services respectively. Limited chemotherapy was available at two hospitals (6%), endocrine therapy at one hospital (3%) and radiotherapy was not available. Twenty-nine hospitals (88%) employed a general practitioner and 13 (39%) employed a surgeon. Oncology specialists, pathology personnel and a plastic surgeon were only available in one hospital (3%) in the Eastern Region.ConclusionsAlthough 16 hospitals (82%) provided screening, only half the population lived within reasonable distance of these services. Few hospitals offered diagnosis and surgical services, but 64% and 78% of the population lived within a reasonable distance of these hospitals. Geospatial analysis suggested two priorities to cost-effectively expand breast cancer services: (1) increase the number of health facilities providing screening services and (2) centralise basic imaging, pathological and surgical services at targeted hospitals.
Many components have notches and notches are in the majority of cases the reason for failure. There are many options to reach a longer lifetime and a better utilisation of material. One method for the shape optimization of components, developed in Forschungszentrum Karlsruhe, uses the design rules of nature. During the last 15 years it has spread very well and proven itself in industry, especially in automotive engineering. The limits for using the CAO-method (Computer Aided Optimization) are more or less of an economic nature. So we need a method that allows optimization by everybody. Now a new pure graphical method has been found, which works without any FEM or optimization software. It is called the "Method of Tensile Triangles" and requires only a set square and a piece of paper to optimize the notch shape in an effective and simple way.
Purpose: To characterize the capacity of healthcare facilities to provide breast cancer care in The Gambia and calculate the proportion of the population with access to services. Methods: A facility-based service assessment tool was administered to all healthcare facilities in The Gambia. Proximity of service availability and population analysis were assessed using GPS coordinates and LandScan population density raster. Distance thresholds of 10km, 25km, and 45km were established to determine access to screening services, pathologic diagnosis, and surgical management, respectively. An additional population analysis was performed to observe the potential impact of targeted resource development. Results: All 102 healthcare facilities were included. Breast cancer screening was mainly performed through clinical breast examination and was available in 52 facilities. Seven facilities provided pathologic diagnosis and surgical management of breast cancer. The proportion of the Gambian population with access to screening, pathologic diagnosis and surgical management was 72%, 57%, and 62%, respectively. Patients living on the eastern side of the country have to travel up to 35 km for screening services and up to 300 km for pathologic diagnosis and surgical management. Widespread implementation of clinical breast examination for screening, and targeted expansion of diagnostic and surgical resources in two hospitals would increase the covered population to 95%, 67%, and 84%. This would decrease the maximum distance to access breast cancer care to 15 km for screening and 90 km for diagnosis and surgical management. Conclusion: Almost half of the Gambian population do not have access to pathologic diagnosis and surgical management of breast cancer within a reasonable travel distance, and all facilities offering these services are located in the capital city. Mapping and population analysis can identify key areas of need. This approach allows targeted development of resources to significantly increase access to breast cancer care in a low resource setting. Citation Format: Fidel Lopez-Verdugo, Meghan Mali, Moustafa Moustafa, Jonathan Nellermoe, Justin Sorensen, Mustapha Bittaye, Ramou Njie, Yankuba Singhateh, Alison Goldsmith, Nuredin I. Mohammed, Raymond R. Price, Edward Sutherland, Ousman Sanyang. Geospatial Analysis and Impact of Targeted Development of Breast Cancer Care in The Gambia: A Cross-Sectional Study [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 19.
Libraries have long participated in collecting, preserving, and providing access to materials. The advancement of technology has allowed libraries to expand collection building and preservation by providing access to anyone with an internet connection. Local histories of unique and hidden stories can now be shared with a greater audience, contributing to new national and international understandings of the forces of culture, society, and government. Such is the case with the Downwinders of Utah Archive, a collection of government documents, letters, newspaper articles, and oral histories sharing the devastating effects associated with living downwind from nuclear testing. While these individual items are available to the public, bringing together geospatial visualizations, statistical information, and storytelling creates an unforgettable and engaging learning experience.
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