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Abstract Network failure is categorized into the two types of software and hardware (physical layer) failure. This paper focuses on the physical layer failure in the wireless sensor and actor networks (WSANs). Actors play an important role in data processing, decision-making, and performing appropriate reactions. Single or multiple nodes failure of actors due to the explosion, energy depletion, or harsh environments, can cause multiple disjoint partitions. This paper has proposed a new computational intelligence-based connectivity restoration (CICR) method. It uses a combination of advanced computational intelligence methods to solve restoration problem. The proposed algorithm applies the novel enhanced Lagrangian relaxation with a novel metaheuristic sequential improved grey wolf optimizer (SIGWO) search space algorithm in simultaneous selection of k sponsor and p pathway nodes. The reactive proposed method aims to reduce the travel distance or moving cost and communication cost. As a result, the restored network has minimum of topology change and energy consumption. In terms of total traveled distance, CICR has 37.19%, 71.47%, and 44.71% improvement in the single-node failure averagely in comparison with HCR, HCARE, and CMH, respectively. Also, it has an average of 61.54%, 40.1%, and 57.76% improvement in comparison with DCR, PRACAR, and RTN in multiple partitions resulted from multiple nodes failure, respectively. The reliability of CICR method has improved averagely by 35.85%, 38.46%, 22.03% over HCR, CMH, and HCARE in single-node failure. In multiple nodes failure, reliability of CICR has averagely 61.54% and 20% over DCR and PRACAR, respectively.

Abstract Background Visits to the primary diabetes care provider play a central role in diabetes care. Therefore, patients should attend their primary diabetes care providers whenever a visit is necessary. Parameters that might affect whether this condition is fulfilled include accessibility (in terms of travel distance and travel time to the practice), as well as aspects of service quality (for example in-practice waiting time and quality of the provider’s communication with the patient). The relationships of these variables with the frequency of visits to the primary diabetes care provider are investigated. Methods The investigation is performed with questionnaire data of 1086 type 2 diabetes patients from study regions in England (213), Finland (135), Germany (218), Greece (153), the Netherlands (296) and Spain (71). Data were collected between October 2011 and March 2012. Data were analysed using log-linear Poisson regression models with self-reported numbers of visits in a year to the primary diabetes care provider as the criterion variable. Predictor variables of the core model were: country; gender; age; education; stage of diabetes; heart problems; previous stroke; problems with lower extremities; problems with sight; kidney problems; travel distance and travel time; in-practice waiting time; and quality of communication. To test region-specific characteristics, the interaction between the latter four predictor variables and study region was also investigated. Results When study regions are merged, travel distance and in-practice waiting time have a negative effect, travel time no effect and quality of communication a positive effect on visit frequency (with the latter effect being by far largest). When region specific effects are considered, there are strong interaction effects shown for travel distance, in-practice waiting time and quality of communication. For travel distance, as well as for in-practice waiting time, there are region-specific effects in opposite directions. For quality of communication, there are only differences in the strength with which visit frequency increases with this variable. Conclusions The impact of quality of communication on visit frequency is the largest and is stable across all study regions. Hence, increasing quality of communication seems to be the best approach for increasing visit frequency.

Abstract Background Research indicate that when general practitioners (GPs) refer their patients for specialist care, the patient often has long distance. This study had a twofold aim: in accordance to the GP’s suspicion of cancer, we investigated the association between: 1) cancer patient’s travel distance to the first specialised diagnostic facility and the GP’s diagnostic strategy and 2) cancer patient’s travel distance to the first specialised diagnostic facility and satisfaction with the waiting time and the availability of diagnostic investigations. Method This combined questionnaire- and registry-based study included incident cancer patients diagnosed in the last 6 months of 2016 where the GP had been involved in the diagnostic process of the patients prior to their diagnosis of cancer (n = 3455). The patient’s travel distance to the first specialised diagnostic facility was calculated by ArcGIS Network Analyst. The diagnostic strategy, cancer suspicion and the GP’s satisfaction with the waiting times and the available investigations were assessed from GP questionnaires. Results When the GP did not suspect cancer or serious illness, an insignificant tendency was seen that longer travel distance to the first specialised diagnostic facility increased the likelihood of the GP using ‘wait-and-see’ approach and ‘medical treatment’ as diagnostic strategies. The GPs of patients with travel distance longer than 49 km to the first specialised diagnostic facility were more likely to report dissatisfaction with the waiting time for requested diagnostic investigations (PR: 1.98, 95% CI: 1.20–3.28). Conclusion A insignificant tendency to use ‘wait-and-see’ and ‘medical treatment’ were seen among GPs of patients with long travel distance to the first diagnostic facility when the GP did not suspect cancer or serious illness. Long distance was associated with higher probability of GP dissatisfaction with the waiting time for diagnostic investigations.

Usually, route choice is performed considering a single objective like considering a single object among travel time, emission, and travel distance. In this article, a methodology has been developed to find the eco-friendly route considering multi-objective-travel time, emission and travel distance. Pareto optimality and weighted product model are used for multi-objective optimization and route choice is done by Dijkstra’s shortest path algorithm. Simulation software, AIMSUN is used to perform micro-simulation for collecting second by second vehicle speed and acceleration profile. Vehicle Specific Power (VSP) model is used to estimate emission. Emission at the traffic network can be significantly reduced by using the vehicle to vehicle communication. Using the V2V communication system, CO2, NOx, CO, HC can be reduced up to 5.34%, 9.57%, 25.84%, and 3.67% respectively in route choice considering budget travel time and travel distance. The difference in route choice pattern has also found considering without and with V2V communication.

Objective (s): To evaluate travel distance in women with advanced or recurrent epithelial ovarian cancer (OC) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) and the subsequent impact upon outcomes. Methods: An IRB-approved single-institution prospective registry was queried for women with OC who underwent HIPEC from 1/1/2009–12/1/2020. Demographic, oncologic, and surgical data were recorded. The patient's home zip code was compared to the institutional zip code to determine travel distance using Google Maps. Patients were divided into three strata for analysis: 1) local: ≤50 miles, 2) regional: 51–99 miles, and 3) distant: ≥100 miles and univariate analysis was performed. Results: Of 127 women, the median distance travelled was 57.0 miles (IQR: 20.6, 84.6). There were no significant differences in mild (28.3% vs. 26.3 vs. 24.1%), moderate (21.7% vs. 15.8% vs. 17.2%) or severe postoperative complications (11.7% vs. 5.3% vs. 17.2%) (p = 0.75) for local, regional and distant patients, respectively. There was no difference in progression-free survival (17.4 vs. 22.2 vs. 12.8 months, p > 0.05) or overall survival (57.3 vs. 61.6 vs. 29.2 months, p > 0.05) for local, regional or distant patients, respectively. Conclusions: This study demonstrates that women with OC are willing to travel for HIPEC, with over 50% traveling > 50 miles. Our results suggest that women who travel for HIPEC procedures are not at increased risk for perioperative complications or worse oncologic outcomes than those local to HIPEC centers.

This paper considers a low-level unit-load warehouse employing single-deep storage lanes and a single-command manual storage and retrieval policy. Analytical travel distance models are developed for class-based and full turnover storage policies under across-aisle, within-aisle and a newly proposed hybrid product placement schemes. Our computational studies show that the analytical models developed in this paper are very accurate as compared to simulation results and a comparative study with a real-world warehouse case. Hybrid storage policies proposed in this paper outperform all other traditional storage policies. The paper also presents insights and simple design rules to warehouse practitioners. [ABSTRACT FROM AUTHOR]

• Better survival with breast conserving therapy versus mastectomy in early breast cancer • Longer travel distance is associated with the receipt of mastectomy over breast conserving therapy • African American patients are disproportionally affected by travel distance • Regardless of race, lack of insurance was associated with the receipt of mastectomy over breast conserving therapy We evaluated the impact of insurance status and travel distance on the receipt of total mastectomy without reconstruction (TM) compared to breast conserving surgery with radiation (BCT) for early-stage breast cancer (BC) patients who received care at a single facility. We hypothesized that, lack of insurance and increased travel distance would be predictive of TM over BCT and disparities would vary by different races and/or ethnicities. Using the National Cancer Database from 2010-2017, we examined surgical patients with stage I or II BC, who received care at one facility. Chi-square tests examined subgroup differences by BCT or TM. Multivariable logistic regressions evaluated patient, facility, and pathologic factors associated with the receipt of TM over BCT for the entire cohort and by races and/or ethnicities. Of the 284,202 patients, 70.1% received BCT while 29.9% received TM. After adjustment travel distance > 60 miles to a treatment facility, and non–insured patients were more likely to receive TM over BCT, when compared to travel distance < 20 miles and private insurance (all P < 0.05). Compared to other races and/or ethnicities, African Americans traveling > 60 miles were 65.4% more likely to receive TM over BCT compared to those traveling < 20 miles (P <.0001). Across all races and/or ethnicities after adjustment, lack of insurance was predictive for receipt of TM over BCT (P < 0.05). Despite treatment at one facility, increased travel distance and insurance status are independently predictive of the receipt of TM over BCT in patients with early-stage BC. While travel distance is particularly impactful for African Americans, the impact of not having insurance on surgical treatments is universal across all races and/or ethnicities. [ABSTRACT FROM AUTHOR]

This study aims to assess the impact of nationwide centralization of surgery on travel distance and travel burden among patients with oesophageal, gastric, and pancreatic cancer according to age in the Netherlands. As centralization of care increases to improve postoperative outcomes, travel distance and experienced burden might increase. All patients who underwent surgery between 2006 and 2017 for oesophageal, gastric and pancreatic cancer in the Netherlands were included. Travel distance between patient's home address and hospital of surgery in kilometres was calculated. Questionnaires were used to assess experienced travel burden in a subpopulation (n = 239). Multivariable ordinal logistic regression models were constructed to identify predictors for longer travel distance. Over 23,838 patients were included, in whom median travel distance for surgical care increased for oesophageal cancer (n = 9217) from 18 to 28 km, for gastric cancer (n = 6743) from 9 to 26 km, and for pancreatic cancer (n = 7878) from 18 to 25 km (all p < 0.0001). Multivariable analyses showed an increase in travel distance for all cancer types over time. In general, patients experienced a physical and social burden, and higher financial costs, due to traveling extra kilometres. Patients aged >70 years travelled less often independently (56% versus 68%), as compared to patients aged ≤70 years. With nationwide centralization, travel distance increased for patients undergoing oesophageal, gastric, and pancreatic cancer surgery. Younger patients travelled longer distances and experienced a lower travel burden, as compared to elderly patients. Nevertheless, on a global scale, travel distances in the Netherlands remain limited. [ABSTRACT FROM AUTHOR]

The present study develops a methodology to assess transportation-related CO2 emissions of European city tourism. In doing so, not only is travel distance considered, but also the chosen transportation modes and the particularities of the different cities' source markets. The major contribution of this study is the implementation of this learning methodology into a decision support system for destination management organizations of cities. Based on a sample from 2018 of 48 European cities with at least 40 source markets, the range of aggregate transportation-related CO2 emissions of European city tourism is estimated. Moreover, a longitudinal analysis of the exemplary city of Vienna covering the period of 1990 to 2018 is carried out. Finally, some policy recommendations of how destination management organizations can contribute to make the estimated transportation-related CO2 emissions even more precise and on how to make European city tourism more environmentally sustainable are drawn. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have found disparities in emergency medical service (EMS) transports for rural residents including double the average response time and lower patient survival rates when compared with their urban counterparts. Since 2012, the rate of rural hospitals closures has risen alarmingly from previous years. Previous studies have linked the closure of rural hospitals to increased EMS transport and total activation time. However, data and methods used in previous studies have not included facility-level characteristics, which limits the ability to tease out the nuances of each closure. Thus, the purpose of this study is to examine the impact of rural hospital closures on EMS travel time, as well as the characteristics of the closed hospitals. Sample: Data sources for the study came from a state-level EMS database, the CMS Provider of Service files, and state-level hospital data reports. Methods: Geographic information system software was used to geocode hospital locations and generate service areas based on drive times. We identified rural hospitals that closed in Alabama between 2010-2018 and then identified the 911 call data from the state's EMS database that occurred within close proximity of each of the hospitals of interest, resulting in a sample of 120,802 EMS calls. Findings: We identified five hospital closures within our time period. For one of the five closures, EMS transport time to the emergency department increased by thirteen minutes post-closure. In two of the five closures, transport time increased by five minutes or less. In two instances, however, transport time decreased. Conclusions: Our findings suggest that not all rural hospital closures result in increased EMS transport times as rural patients may have already been routinely transported to alternate hospitals. Additionally, specific characteristics of a hospital pre-closure may be related to changes in EMS travel times that occur post-closure. [ABSTRACT FROM AUTHOR]

Purpose: Prior research shows that residential distance to a treatment facility may be an important factor in central nervous system (CNS) tumor outcomes. Our goal was to examine residential distance to the reporting hospital and overall survival in adolescents and young adults (AYA) diagnosed with CNS tumors. Methods: National Cancer Database data on AYA 15–39 years old diagnosed with CNS and Other Intracranial and Intraspinal Neoplasms (CNS tumors) from 2010 to 2014 were obtained. Distance between the case's residence at diagnosis or initial treatment and the reporting hospital was classified in miles as short (≤ 12.5), intermediate (> 12.5 and < 50), and long (≥ 50). Cox proportional hazards regression models were used for analyses. Results: Among 9335 AYA diagnosed with CNS tumors, hazard ratios (HRs) were 1.06 (95% CI 0.96–1.17) and 0.82 (95% CI 0.73–0.93) for those with residences at intermediate and long vs. short distances, respectively, after adjusting for age, sex, race/ethnicity, and zip-code level education and income. After adjusting for the facility volume of CNS tumor patients, the association was attenuated for long vs. short distance residences (HR 0.92, 95% CI 0.81–1.04). The HRs varied by tumor type, race/ethnicity, and zip-code level income with significantly lower hazards of death for those with residences at long vs. short distances for low-grade astrocytic tumors, ependymomas, non-Hispanic Whites, and those from higher-income areas. Conclusions: Living at long distances for CNS tumor care may be associated with better survival in AYA patients. This may be explained by travel to facilities with more experience treating CNS tumors. [ABSTRACT FROM AUTHOR]

Plastic accumulation in the marine environment is a major concern given the harmful effects and longevity of plastics at sea. Although rivers are likely to significantly contribute to the flux of plastic to marine systems, the behaviour of plastic debris in fluvial systems remains poorly understood and estimates of riverine plastic flux derived from field measurements and modelling efforts are highly uncertain. This paper presents a new probabilistic model of plastic transport in rivers which describes the main processes controlling plastic displacement and which predicts the statistical distribution of travel distances for individual items of buoyant macroplastic debris. Macroplastic transport is controlled by retention in temporary stores (or traps) created by vegetation, bank roughness elements and other obstacles. The behaviour of these traps is represented in the model via a series of Bernoulli trials conducted in a Monte Carlo simulation framework. The model was applied to a tracer experiment in a small 1.1 km river reach. Three replicates were used for calibration and three for validation. For each replicate, 90 closed air-filled polyethylene terephthalate (PET) bottles were introduced at the upstream end of the reach and the location of each bottle was recorded after 24 h. Bottles were chosen as “model” macroplastic litter items given their high usage and littering rate. Travel distances were low. The average and maximum distances travelled over 24 h were 231 m and 1.1 km, respectively. They were also variable. The coefficient of variation of travel distances was 0.94. Spatial patterns were controlled by the location and characteristics of discrete traps. The model was able to describe the observed travel distance distributions reasonably well, suggesting that modelling plastic behaviour in longer reaches and even whole catchments using a stochastic travel distance approach is feasible. The approach has the potential to improve estimates of river plastic flux, although significant knowledge gaps remain (e.g., the rate and location of plastic supply to river systems, the transport behaviours of different types of plastic debris and trap effectiveness in different types of river system, season, and discharge).

Purpose: Cancer patients have to overcome various barriers to obtain diagnostics and treatment at head and neck cancer centers. Travel distance to a specialized hospital may result in psychosocial and financial distress, thus interfering with diagnostics, treatment, and follow-up care. In this study, we have aimed to analyze the association of travel distance with cTNM status, UICC stage at primary diagnosis, and survival outcomes of head and neck cancer (HNC) patients. Methods: We have analyzed data of 1921 consecutive HNC patients diagnosed between 2014 and 2019 at the head and neck cancer center of the Comprehensive Cancer Center Ulm (CCCU), Germany. Postal code-based travel distance calculation in kilometers, TNM status, and UICC stage were recorded at initial diagnosis. The assembly of travel distance-related groups (short, intermediate, long-distance) has been investigated. Moreover, group-related survival and recurrence analysis have been performed. Results: In contrast to observations from overseas, no association of travel distance and higher cTNM status or UICC stage at primary diagnosis has been observed. Furthermore, no significant differences for recurrence-free survival and overall survival by travel distance were detected. Conclusion: In southern Germany, travel distance to head and neck cancer centers seems to be tolerable. Travel burden is not synonymous with travel distance alone but also involves sociodemographic, monetary, and disease-specific aspects as well as accessibility to proper infrastructure of transport and health care system. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of the modifiable areal unit problem (MAUP) in an investigation of factors associated with ED demand in Perth, Western Australia, in 2016. Furthermore, to advocate a means of avoiding this impact. Methods: ED presentations were classified as: urgent medical, non‐urgent medical, urgent trauma or non‐urgent trauma. In each group, sex‐stratified, age‐adjusted multivariate associations with socio‐economic status and distance to the nearest ED and general practitioner (GP) were estimated. Modelling was undertaken using different sets of spatial units: Australian Bureau of Statistics (ABS) Statistical Areas Level 1 (SA1s) and numerous aggregate‐level zonations of SA1s (ABS SA2s and others). Results: Estimates obtained using the different units often varied widely: for seven (30%) of 24 strata defined by combinations of sex, ED type and covariate, the smallest and largest effect sizes differed in terms of direction; further, for 11 (65%) of the remaining 17 strata, the largest effect size was at least twice as high as the smallest. This demonstrates the MAUP's impact and that analyses based on a single set of spatial units are unreliable. To resolve the observed variation, we highlight the SA1‐level estimates. Conclusions: When formulating interventions targeting reduced ED utilisation, policy planners should be guided by evidence based on analysis of appropriate spatial units. This ideal is undermined by the widespread lack of acknowledgement of the MAUP in studies examining drivers of ED demand using spatially aggregated data. To avoid the MAUP, only estimates obtained through examining a minimal geographic unit should be relied upon. [ABSTRACT FROM AUTHOR]

A considerable number of empirical studies have explored the effects of information & communication technologies (ICT) on travel in recent years. In particular, the most attention has been paid to whether the use of ICT increases or decreases trip frequency (i.e., substitution or complementarity effects). However, the subject of whether or how travel distance and mode choice are altered by ICT (i.e., modification effects) has almost been ignored. Against this background, using data collected in Beijing, China, this paper aims to explore how purchasing intangible services (e.g., eating out at restaurants, hairdressing, and visits to zoos and movie theatres) online alters the distance and mode choice of the travel to consume these services. The results suggest that due to online purchases of intangible services, people tend to travel farther to consume these services. Consequently, 25.4% of online buyers change their travel mode choices from walking or cycling (i.e., nonmotorized modes) to public transit, private cars, or taxis (i.e., motorized modes). These findings confirm the existence of modification effects of ICT on travel. Additionally, a stepwise multinomial logistic regression model and a stepwise binomial logistic regression model are used to detect the factors influencing changes in travel distance and mode choices, respectively. The regression outcomes suggest that people who have lower living costs or feel more satisfied with online purchases are more likely to increase their travel distances and to change from nonmotorized modes to motorized modes. [ABSTRACT FROM AUTHOR]

Abstract Background Guidelines recommend treatment of retroperitoneal sarcomas (RPS) at high-volume centers. However, high-volume centers may not be accessible locally. This national study compared outcomes of RPS resection between local low-volume centers and more distant high-volume centers. Methods Patients treated for RPS were identified from the National Cancer Database (1998–2012). Travel distance and annual hospital volume were divided into quartiles. Two groups were identified: (1) short travel to low-volume hospitals (ST/LV), (2) long travel to high-volume hospitals (LT/HV). Outcomes were adjusted for clinical, tumor, and treatment characteristics. Results Two thousand five hundred ninety-nine patients met the inclusion criteria. The LT/HV cohort was younger and more often white (p

The spatial characteristics of residents' leisure activities not only reflect their demand for urban leisure space but also affect the urban spatial layout. This study takes Shenyang, China as an example and analyzes the characteristics of residents' leisure activities through questionnaires. On this basis, it uses point of interest data and mobile phone signaling data to identify various types of residential and leisure functional relationships, and uses spatial analysis and community detection to assess the distance characteristics, flow patterns, and community structure of residents' leisure activities, so as to discuss the spatial structure of residents' leisure activities in Shenyang. The results showed that: 1) in addition to leisure at home, Shenyang residents mainly went to shopping malls, supermarkets, and parks for leisure activities, and the proportions of residents of the two types of leisure activities were approximately equal; 2) the average distances that residents traveled for shopping and park leisure were near in the middle and far in the periphery, and the travel costs of peripheral residents for centrally located leisure were higher than those for residents in central areas; 3) the flow patterns of the residential-shopping and residential-park functional relationships displayed clustering mode characteristics, and Shenyang presented a significant monocentric structure; and 4) residents' shopping activities were concentrated in the southern community, and walking in the park activities were concentrated in the western community. Residents' leisure activities were characterized by centripetal agglomeration, which was prone to problems such as traffic congestion and big city diseases. The spatial expansion process in the city was characterized by obvious directional inheritance and path dependence, and the construction of sub-cities is needed to improve the related service facilities. [ABSTRACT FROM AUTHOR]

The debris from exploded buildings can ricochet after colliding with the ground, thus increasing the debris travel distance and danger from any associated impacts or collisions. To reduce this danger, the travel distance of ricocheted debris must be accurately predicted. This study analyzed the change in the travel distance of ricocheted concrete debris relative to changes in the properties of a sand medium. Direct shear tests were conducted to measure the change in internal friction angle as a function of temperature and water content of the sand. Finite element analysis (FEA) was then applied to these variables to predict the speed and angle of the debris after ricochet. The FEA results were compared with results of low-speed ricochet experiments, which employed variable temperature and water content. The travel distance of the debris was calculated using MATLAB, via trajectory equations considering the drag coefficient. As the internal friction angle decreased, the shear stress decreased, leading to deeper penetration of the debris into the sand. As the loss of kinetic energy increased, the velocity and travel distance of the ricocheted debris decreased. Changes in the ricochet velocity and travel distance of the debris, according to changes in the internal friction angle, indicated that the debris was affected by the environment. [ABSTRACT FROM AUTHOR]

The extensive proliferation of smartphones presents a new opportunity for precise indoor and outdoor location-based services. Although various smartphone-based positioning technologies have been investigated, no practical and economical method has been developed where global positioning system (GPS) cannot be applied. Since it is difficult to estimate travel distance accurately with a low-cost inertial sensor embedded in a smartphone, several methods have been proposed to estimate stride. However, the estimation of stride is not accurate as it depends on walking posture. In this article, a novel approach is proposed to estimate the travel distance of the smartphone using optical flow (OF) technology, which is applied to the video image captured from the smartphone camera. Several algorithms have been developed to solve various problems that occur when a user walks holding a smartphone. The feature trace method proposed in this article improves the travel distance estimation accuracy greatly. Several motion compensation methods for the OF are proposed also using smartphone sensor data. The performance of the proposed methods is verified by experiments in three different places with two kinds of smartphones. The estimation accuracy of the travel distance by the proposed method is obtained from all the experimental data. As a result, the average travel distance error rate is 2.6%; for the 5% distance error rate, the error CDF is 86%; and for the 10%, it is 100%. The proposed methods could be applied to track the smartphone of the pedestrian with precise position accuracy indoors and outdoors. [ABSTRACT FROM AUTHOR]

Purpose: Iowa is among several rural Midwestern states with the highest proportions of contralateral prophylactic mastectomy (CPM) in women < 45 years of age. We evaluated the role of rurality and travel distance in these surgical patterns. Methods: Women with unilateral breast cancer (2007–2017) were identified using Iowa Cancer Registry records. Patients and treating hospitals were classified as metro, nonmetro, and rural based on Rural–Urban Continuum Codes. Differences in patient, tumor, and treatment characteristics and median travel distance (MTD) were compared. Characteristics associated with CPM were evaluated with multivariate logistic regression. Results: 22,158 women were identified: 57% metro, 26% nonmetro and 18% rural. Young rural women had the highest proportion of CPM (52%, 39% and 40% for rural, metro, nonmetro women < 40 years). Half of all rural women had surgery at metro hospitals; these women had the longest MTD (62 miles). Among all women treated at metro hospitals, rural women had the highest proportion of CPM (17% rural vs 14% metro/nonmetro, p = 0.007). On multivariate analysis, traveling ≥ 50 miles (ORs 1.43–2.34) and rural residence (OR = 1.29) were independently predictive of CPM. Other risk factors were young age (< 40 years: OR = 7.28, 95% CI 5.97–8.88) and surgery at a metro hospital that offers reconstruction (OR = 2.30, 95% CI 1.65-3.21) and is not NCI-designated (OR = 2.34, 95% CI 1.92–2.86). Conclusion: There is an unexpectedly high proportion of CPM in young rural women in Iowa, and travel distance and availability of reconstructive services likely influence decision-making. Improving access to multidisciplinary care in rural states may help optimize decision-making. [ABSTRACT FROM AUTHOR]

Despite growing concern about climate change and the potential impacts of tourism on the environment, little is known about visitor responses toward climate mitigation strategies in nature-based tourism settings or factors that influence them. This study examined the influence of travel distance and Experience Use History (EUH) on visitor willingness to engage in climate friendly behavior in state parks and their support for management actions to minimize climate change impacts. Following a stratified-cluster sampling approach, a total of 1,775 visitors (69.7% response rate) completed online or paper surveys at 20 pre-selected Missouri state parks and historic sites. Results indicated that visitors living within 100 miles of these locations were more willing to engage in climate friendly behavior, but less supportive of climate friendly management actions, as compared to those living farther away. Visitors' EUH was only associated with their willingness to engage in climate friendly behavior, but not with support for climate friendly management actions. In addition to some theoretical and methodological contributions, this paper sheds light on management of nature-based tourism destinations such as state parks. [ABSTRACT FROM AUTHOR]

Background: Telemedicine is increasingly utilized as an alternative to in person consultation. Current pandemic conditions are providing additional impetus to virtual care delivery. We compared both adolescent and caregiver (parent or guardian) attitudes towards telemedicine (here as tertiary center to remote health care location) as a crucial determinant of longer-term effectiveness.Methods: This qualitative research study analyzed transcribed structured telephone interviews with both 11-18 year-old pediatric nephrology patients and their caregivers and performed a quantitative analysis of patient demographics, disease factors and distance to tertiary center vs. telemedicine center.Results: The study was conducted in a medium-sized tertiary pediatric nephrology centre with a large catchment area of over 0.5 million square kilometers and 629,000 children and adolescents under 18 years of age. Eleven dyads of adolescents and caregivers were enrolled. Five adolescents were male. The mean age of the adolescents was 14.4 ± 2.5 years (range 11.2-18.0). The median distance to our tertiary center was 191 km (range 110-1378 km). Four adolescents lived more than 500 km from our tertiary center. The 11 adolescents had a total of 334 in person visits (mean 30 ± 25) and 86 telemedicine visits (mean 8 ± 7). A ratio of 2:1 telemedicine to in-person visits was favored; with caregivers more in favor of remote care than adolescents. Qualitative analysis found that experiences with telemedicine were distinguished by consultation-specific factors and contextual factors. Contextual factors (travel/cost savings) were valued for telemedicine by adolescents and caregivers. Consultation-specific factors, such as the ability to show the doctor physical symptoms, were more valued during in-person consultations, especially by adolescents. The overall visit type preference was related to the nature of the consultation. For regular check-ups, and for adolescents with less complex needs, participants felt that telemedicine offered a comparable experience to in-person visits. Adolescents with more complex conditions preferred in-person visits.Conclusions: Indiscriminate transfer to chronic care predicated on mainly telemedicine approach is not compatible with user expressed attitudes (especially among adolescents). Accurately mapping models of care to these attitudes is an essential determinant of effective management and longer-term engagement with potentially life-long health challenges. [ABSTRACT FROM AUTHOR]

Using USDA's National Household Food Acquisition and Purchase Survey (FoodAPS), we estimated block group‐level spending‐weighted mean distance to the retailers where consumers actually shop (3.9 miles overall; 7.0 miles in rural areas and 3.0 miles in urban areas). Holding constant retailer type, every 10% increase in travel distance was associated with a 3.5% decrease in the food‐at‐home spending share. If consumers travel farther to get food, it may signal that they lack satisfactory options at closer distances. Spending‐weighted mean travel distance could support measures of food retail gaps that are consistent both with consumers' revealed preferences and retailers' incentives. [ABSTRACT FROM AUTHOR]

Background: Transportation barriers limit access to cancer care services and contribute to suboptimal clinical outcomes. Our objectives were to describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits.Methods: Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed a mailed survey to assess perceived barriers to recommended care. Participants who reported difficulty with transportation to or from CRC care appointments were categorized as experiencing transportation barriers. We assessed pairwise correlations between transportation barriers, transportation-related factors (e.g., mode of travel), and chaotic lifestyle (e.g., predictability of schedules), and used logistic regression to examine the association between the reporting of transportation difficulties, distance traveled to the nearest Veterans Affairs (VA) facility, and life chaos.Results: Of the 115 Veterans included in this analysis, 18% reported experiencing transportation barriers. Distance to the VA was not strongly correlated with the reporting of transportation barriers (Spearman's ρ = 0.12, p = 0.19), but chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman's ρ = 0.22, p = 0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant.Conclusions: Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience greater life chaos. Identifying Veterans who experience chaotic lifestyles would allow for timely engagement in behavioral interventions (e.g., organizational skills training) and with support services (e.g., patient navigation). [ABSTRACT FROM AUTHOR]

Background: Patients seeking bariatric surgery are traveling longer distances to reach Bariatric Centers. The purpose of this study was to evaluate the impact of travel distance on adherence to follow-up and outcomes after bariatric surgery. Methods: A retrospective review of all consecutive patients who had undergone bariatric surgery from June 2013 to May 2014 was performed, and the patients were divided into two groups: those who traveled 50 miles or less and those who traveled more than 50 miles. Primary outcome assessed was the influence of distance on post-operative follow-up attrition over 4-year period. Secondary outcomes assessed were excess weight loss, length of stay (LOS), complications and readmission rates. Results: A total of 228 patients underwent bariatric surgery with 4 years of follow-up available. Of these, 145 patients traveled 50 miles or less and 83 patients traveled greater than 50 miles. Patient demographics were similar between the two groups. Those who traveled more had statistically higher probability of attrition up to 3-year follow-up mark. There was no difference in percent excess weight loss at each follow-up visit between the two cohorts. Furthermore, there was no difference in readmission rates (2% vs 5%), minor complications (14% vs 10%), major complications (3% vs 2%) and LOS (2.6 days vs 2.6). Conclusion: The distance patients traveled for bariatric surgery did not affect their weight loss success, length of stay, postsurgical complications or readmission rate. Despite the lack of influence on postoperative outcomes, follow-up compliance was statistically affected by distance. [ABSTRACT FROM AUTHOR]

ObjectivesStereotactic Body Radiation Therapy (SBRT) offers definitive treatment for localized prostate cancer with comparable efficacy and toxicity to conventionally fractionated radiotherapy. Decreasing the number of treatment visits from over 40 to five may ease treatment burden and increase accessibility for logistically challenged patients. Travel distance is one factor that affects a patient’s access to treatment and is often related to geographic location and socioeconomic status. In this study, we review the demographic and geographic factors of patients treated with SBRT for prostate cancer for a single institution with over a decade of experience.MethodsPatient zip codes from one thousand and thirty-five patients were derived from a large, prospectively maintained quality of life database for patients treated for prostate cancer with SBRT from 2008 to 2017. The geospatial distance between the centroid of each zip code to our institution was calculated using the R package Geosphere. Characteristics for seven hundred and twenty-one patients were evaluated at the time of analysis including: race, age, and insurance status. To assess the geographic reach of our institution, we evaluated the demographic features of each zip code using US Census data. Statistical comparisons for these features and their relation to distance traveled for treatment was performed using the Mann-Whitney U test. Finally, an unsupervised learning algorithm was performed to identify distinct clusters of patients with respect to median income, racial makeup, educational level, and rural residency.ResultsPatients traveled from 246 distinct zip codes at a median distance of 11.35 miles. Forty percent of patients were African American, 6.9% resided in a rural region, and 22% were over the age of 75. Using K-means cluster analysis, four distinct patient zip-code groups were identified based on the aforementioned demographic features: Suburban/high-income (45%), Urban (30%), Suburban/low-income (17%), and Rural (8%). For each of the clusters, the average travel distance for SBRT was significantly different at 11.17, 9.26, 11.75, and 40.2 miles, respectively (p-value:

Background: Although many children with diseases of the kidneys and the urinary tract may not tolerate long journeys, the number of facilities that provide specialized care for these patients is limited. Therefore, the geographical accessibility of the required health services is critical especially in this patient group. We have analyzed the geographical accessibility of pediatric inpatient and nephro-urology services in Germany, Ireland, and the United Kingdom (UK).Methods: This study introduces a model to compare countries or regions regarding the geographical accessibility of their health services. We calculated the geodesic distances, travel distances, and travel time by car from evenly distributed random points to the nearest facilities that provide pediatric inpatient or nephro-urology outpatient services (pediatric inpatient ward, urology clinic, nephrology clinic, hemodialysis unit). The results were weighted by population density. We compared the three countries with regard to the accessibility of the named services.Results: Weighted median travel times from the random points to the nearest pediatric inpatient ward are < 30 min in all countries. Weighted travel times to the nearest point of pediatric service are shortest in the UK (median

The investigation of landslides applying various methods has been receiving increased attention in recent years. This study was aimed at assessing the estimated distribution of landslide movement using an energy conservation formula in a lumped mass model to obtain velocity and travel distance estimations, in combination with an inverted resistivity model for estimating the Amahusu landslide volume. The research location was in the Amahusu hills of the Nusaniwe subdistrict, Ambon, Indonesia. A survey was carried out using GPS and a geoelectric resistivity method with the Wenner-Schlumberger configuration. The results of the study provide a characterization of this rotational type landslide. The estimated landslide volume was 70,954 m3 and the estimated potential landslide volume was 50,603 m3. This mass moved 303 m away from the original location, with an estimated maximum velocity of up to 21.25 m/s. The displacement pattern of a landslide mass is primarily controlled by the geometry of the sliding plane. The geometry of the sliding plane causes different types of movement, based on which the possible occurrence of a future landslide can be predicted.

Objectives: Stereotactic Body Radiation Therapy (SBRT) offers definitive treatment for localized prostate cancer with comparable efficacy and toxicity to conventionally fractionated radiotherapy. Decreasing the number of treatment visits from over 40 to five may ease treatment burden and increase accessibility for logistically challenged patients. Travel distance is one factor that affects a patient's access to treatment and is often related to geographic location and socioeconomic status. In this study, we review the demographic and geographic factors of patients treated with SBRT for prostate cancer for a single institution with over a decade of experience. Methods: Patient zip codes from one thousand and thirty-five patients were derived from a large, prospectively maintained quality of life database for patients treated for prostate cancer with SBRT from 2008 to 2017. The geospatial distance between the centroid of each zip code to our institution was calculated using the R package Geosphere. Characteristics for seven hundred and twenty-one patients were evaluated at the time of analysis including: race, age, and insurance status. To assess the geographic reach of our institution, we evaluated the demographic features of each zip code using US Census data. Statistical comparisons for these features and their relation to distance traveled for treatment was performed using the Mann-Whitney U test. Finally, an unsupervised learning algorithm was performed to identify distinct clusters of patients with respect to median income, racial makeup, educational level, and rural residency. Results: Patients traveled from 246 distinct zip codes at a median distance of 11.35 miles. Forty percent of patients were African American, 6.9% resided in a rural region, and 22% were over the age of 75. Using K-means cluster analysis, four distinct patient zip-code groups were identified based on the aforementioned demographic features: Suburban/high-income (45%), Urban (30%), Suburban/low-income (17%), and Rural (8%). For each of the clusters, the average travel distance for SBRT was significantly different at 11.17, 9.26, 11.75, and 40.2 miles, respectively (p-value: <0.001). Conclusions: Distinct demographic features are related to travel distance for prostate SBRT. In our large cohort, travel distance did not prevent uptake of prostate SBRT in African American, elderly or rural patient populations. Prostate SBRT offers a diverse population modern treatment for their localized prostate cancer and particularly for those who live significant distances from a treatment center. [ABSTRACT FROM AUTHOR]

The objective of this article is to describe a secondary data analysis of the 2008 Abortion Patient Survey (APS 2008) data exploring the association between intimate partner violence (IPV) and travel distances in a national sample of patients seeking abortion services in the United States. The researchers used the 2008 APS, which is the most recent publicly available version of this dataset, to conduct chi-square tests to examine the bivariate associations between all independent and dependent variables. Prevalence ratios were calculated to determine the association between physical and sexual violence and distance traveled to get an abortion, controlling for length of pregnancy, age, education, income, poverty category, race, relationship status, insurance type, whether women went to the closest clinic, whether the pregnancy was wanted, and number of previous abortions. Results indicate that approximately 83% of the women traveled between 1 and 50 miles, 11% traveled between 51 and 100 miles, 4% traveled between 101 and 150 miles, and 3% traveled more than 151 miles to get an abortion. Prevalence ratios (PR) reveal that physical violence was significantly associated with distance traveled to get an abortion (PR = 1.15, p <.05) when all control variables were accounted for. Patients in abusive relationships that involve physical violence may have to travel longer distances to access abortion. Repeal of policy that impedes access to abortion is recommended. [ABSTRACT FROM AUTHOR]

Mobility is an important element of landslide hazard and risk assessments yet has been seldom studied for shallow landslides and debris flows in tropical environments. In September 2017, Hurricane Maria triggered > 70,000 landslides across Puerto Rico. Using aerial imagery and a lidar digital elevation model (DEM), we mapped and characterized the mobility of debris slides and flows in four different geologic materials: (1) mudstone, siltstone, and sandstone; (2) submarine basalt and chert; (3) marine volcaniclastics; and (4) granodiorite. We used the ratio of landslide-fall height (H) to travel length (L), H/L, to assess the mobility of landslides in each material. Additionally, we differentiated between landslides with single and multiple source areas and landslides that either did or did not enter drainages. Overall, extreme rainfall contributed to the mobility of landslides during Hurricane Maria, and our results showed that the mobility of debris slides and flows in Puerto Rico increased linearly as a function of the number of source areas that coalesced. Additionally, landslides that entered drainages were more mobile than those that did not. We found that landslides in soils developed on marine volcaniclastics were the most mobile and landslides in soils on submarine basalt and chert were the least mobile. While landslides were generally small (< 100 m2) and displayed a wide range of H/L values (0.1–2), coalescence increased the mobility of landslides that transitioned to debris flows. The high but variable mobility of landslides that occurred during Hurricane Maria and the associated hazards highlight the importance of characterizing and understanding the factors influencing landslide mobility in Puerto Rico and other tropical environments. [ABSTRACT FROM AUTHOR]

• E-shopping for intangible services is likely a challenge for the transportation system. • The effect of spatial attributes on travel distance and duration is attenuated by online shopping. • Spatial interventions aiming to moderate travel distances and durations may not be as effective as before. E-shopping for intangible services (e.g., eating out services, hairdressing, and visits to movie theatres) refers to searching and paying for services online, but it requires e-shoppers to travel to use these services. In theory, e-shoppers' search space via the internet is less constrained by spatial attributes. As a result, spatial attributes may barely affect the distance and duration of trips resulting from e-shopping for intangible services. The present study used data from 714 valid face-to-face interviews in Beijing, China, to verify this hypothesis. The results showed that e-shoppers were likely to travel farther after purchasing intangible services online. The effect of spatial attributes on the distance of a single trip was largely attenuated due to online purchases of these services, and the effect on the duration was correspondingly weaker to a limited extent. Therefore, spatial interventions aiming to moderate travel distances and durations may not be as effective in the age of online shopping. [ABSTRACT FROM AUTHOR]

Network failure is categorized into the two types of software and hardware (physical layer) failure. This paper focuses on the physical layer failure in the wireless sensor and actor networks (WSANs). Actors play an important role in data processing, decision-making, and performing appropriate reactions. Single or multiple nodes failure of actors due to the explosion, energy depletion, or harsh environments, can cause multiple disjoint partitions. This paper has proposed a new computational intelligence-based connectivity restoration (CICR) method. It uses a combination of advanced computational intelligence methods to solve restoration problem. The proposed algorithm applies the novel enhanced Lagrangian relaxation with a novel metaheuristic sequential improved grey wolf optimizer (SIGWO) search space algorithm in simultaneous selection of k sponsor and p pathway nodes. The reactive proposed method aims to reduce the travel distance or moving cost and communication cost. As a result, the restored network has minimum of topology change and energy consumption. In terms of total traveled distance, CICR has 37.19%, 71.47%, and 44.71% improvement in the single-node failure averagely in comparison with HCR, HCARE, and CMH, respectively. Also, it has an average of 61.54%, 40.1%, and 57.76% improvement in comparison with DCR, PRACAR, and RTN in multiple partitions resulted from multiple nodes failure, respectively. The reliability of CICR method has improved averagely by 35.85%, 38.46%, 22.03% over HCR, CMH, and HCARE in single-node failure. In multiple nodes failure, reliability of CICR has averagely 61.54% and 20% over DCR and PRACAR, respectively. [ABSTRACT FROM AUTHOR]

Minimizing the travel distance of a picking tour is often considered an imperative factor in improving warehouse operation efficiency. This paper concentrates on the performance of the genetic algorithm (GA) method and its comparison to other routing strategies such as heuristics, the experienced warehouse picker and the brute-force algorithm under given assumptions. The set of simulations and calculations is based on an industrial case example. The results of the investigated routing strategies under given assumptions (middle size dual-zone warehouse, order size - 15 items, etc.) show the dominance of the brute-force algorithm in comparison to the experienced picker, GA and simple heuristics. It also indicates that GA is an optimization method which needs modification in dealing with picking path optimization problems and under given assumptions could generate better solutions than simple heuristics and comparable to experienced picker. The results also show quite significant sensitivity of GA results on used selection operator, size of population and number of generations. [ABSTRACT FROM AUTHOR]

Purpose: Major cancer surgeries have regionalized to fewer and higher‐volume hospitals, with the goal of improving the quality of surgical care. However, regionalization may have negative effects on geographic access to care. We hypothesize that lung cancer patients have been traveling further for surgery over time as regionalization has occurred, and this increased travel has primarily impacted rural patients. Methods: A North Carolina all‐payer state discharge database was used to capture discharges from 2005 to 2015 for patients undergoing lung cancer resection. Changes in patterns of care over time in high‐volume centers (HVC) were examined. Adjusted patient straight‐line travel distance was estimated over time and stratified by rural‐urban location. Findings: The number of hospitals performing lung cancer resections decreased from 49 to 31 over the study period (P =.0006), and the proportion of patients receiving care at HVC increased from 23% to 44% (P <.0001). Rural patient travel distance increased over time by 8.5 miles (95% CI: 0.56‐17.10, P =.048), from 45.1 to 53.6 miles. There was no change in urban patient travel distance. The difference in adjusted travel distance between rural and urban patients nearly doubled from 2005 to 2015 (9.6 to 17.9 miles,P <.0001). Conclusion: In North Carolina, lung cancer surgical regionalization occurred over the study period and was accompanied by increases in travel distance for rural patients only. Further work is needed to determine the effects of greater travel distance on patterns of cancer care for rural patients. [ABSTRACT FROM AUTHOR]

Background: Visits to the primary diabetes care provider play a central role in diabetes care. Therefore, patients should attend their primary diabetes care providers whenever a visit is necessary. Parameters that might affect whether this condition is fulfilled include accessibility (in terms of travel distance and travel time to the practice), as well as aspects of service quality (for example in-practice waiting time and quality of the provider's communication with the patient). The relationships of these variables with the frequency of visits to the primary diabetes care provider are investigated.Methods: The investigation is performed with questionnaire data of 1086 type 2 diabetes patients from study regions in England (213), Finland (135), Germany (218), Greece (153), the Netherlands (296) and Spain (71). Data were collected between October 2011 and March 2012. Data were analysed using log-linear Poisson regression models with self-reported numbers of visits in a year to the primary diabetes care provider as the criterion variable. Predictor variables of the core model were: country; gender; age; education; stage of diabetes; heart problems; previous stroke; problems with lower extremities; problems with sight; kidney problems; travel distance and travel time; in-practice waiting time; and quality of communication. To test region-specific characteristics, the interaction between the latter four predictor variables and study region was also investigated.Results: When study regions are merged, travel distance and in-practice waiting time have a negative effect, travel time no effect and quality of communication a positive effect on visit frequency (with the latter effect being by far largest). When region specific effects are considered, there are strong interaction effects shown for travel distance, in-practice waiting time and quality of communication. For travel distance, as well as for in-practice waiting time, there are region-specific effects in opposite directions. For quality of communication, there are only differences in the strength with which visit frequency increases with this variable.Conclusions: The impact of quality of communication on visit frequency is the largest and is stable across all study regions. Hence, increasing quality of communication seems to be the best approach for increasing visit frequency. [ABSTRACT FROM AUTHOR]

The concentration of activities in the certain areas triggers traffic movements. Different land use generates different amount of traffic, causing different level of traffic delay and air pollutant. Currently, an appropriate policy has not formulated to overcome the concentration of activities related to different road corridors. Therefore, traffic demand management (TDM) should be arranged in order to decrease air pollution regarding to different road corridors. For this reason, this study estimates traffic performance and social costs due to air pollutant emission for different land uses in the city of Malang, East Java, Indonesia. This analysis is based on IHCM (Indonesian Highway Capacity Manual). An approach to estimating pollution costs is based on speed and travel distance in each road corridor. Highway performance for warehousing area has a poor service level. Based on speed analysis, huge concentrations of air pollution such as NO, HC and CO2 have a significant negative impact on the road corridor as a warehousing area. Another analysis based on travel distance also resulted in the highest air pollution cost on road corridor as a warehousing area. To minimize air pollution cost, the local government should have an effort to reduce air pollution cost by implementing TDM strategies such as minimizing road side friction. [ABSTRACT FROM AUTHOR]

Purpose: The distance patients travel for specialty care is an important barrier to health care access, particularly for those living in rural areas. This study characterizes the actual distance older breast cancer patients traveled to radiation treatment and the minimum distance necessary to reach radiation care, and examines whether any patient demographic or clinical factors are associated with greater travel distance. Methods: We used data from the Surveillance Epidemiology and End Results (SEER)‐Medicare database. Our cohort included 52,317 women diagnosed with breast cancer between 2004 and 2013. Driving distances were calculated using Google Maps. We used generalized estimating equations to estimate associations between patient demographic and disease variables and travel distance. Findings: Patients living in rural areas traveled on average nearly 3 times as far as those from urban areas (40.8 miles vs 15.4 miles), and their nearest facility was more than 4 times farther away (21.9 miles vs 4.8 miles). Older age, being single or widowed, and lower household income were significantly associated with shorter actual travel distance, while increasing rurality was significantly associated with greater actual and minimum travel distance to radiation treatment. Disease severity (stage, grade, etc) was not significantly associated with actual or minimum travel distance. Conclusions: In this insured population, travel distance to radiation facilities may pose a significant burden for breast cancer patients, particularly among those living in rural areas. Policymakers and patient advocates should explore service delivery models, reimbursement models, and social supports aimed at reducing the impact of travel to radiation treatment for breast cancer patients. [ABSTRACT FROM AUTHOR]

Background: Research indicate that when general practitioners (GPs) refer their patients for specialist care, the patient often has long distance. This study had a twofold aim: in accordance to the GP's suspicion of cancer, we investigated the association between: 1) cancer patient's travel distance to the first specialised diagnostic facility and the GP's diagnostic strategy and 2) cancer patient's travel distance to the first specialised diagnostic facility and satisfaction with the waiting time and the availability of diagnostic investigations. Method: This combined questionnaire- and registry-based study included incident cancer patients diagnosed in the last 6 months of 2016 where the GP had been involved in the diagnostic process of the patients prior to their diagnosis of cancer (n = 3455). The patient's travel distance to the first specialised diagnostic facility was calculated by ArcGIS Network Analyst. The diagnostic strategy, cancer suspicion and the GP's satisfaction with the waiting times and the available investigations were assessed from GP questionnaires. Results: When the GP did not suspect cancer or serious illness, an insignificant tendency was seen that longer travel distance to the first specialised diagnostic facility increased the likelihood of the GP using 'wait-and-see' approach and 'medical treatment' as diagnostic strategies. The GPs of patients with travel distance longer than 49 km to the first specialised diagnostic facility were more likely to report dissatisfaction with the waiting time for requested diagnostic investigations (PR: 1.98, 95% CI: 1.20–3.28). Conclusion: A insignificant tendency to use 'wait-and-see' and 'medical treatment' were seen among GPs of patients with long travel distance to the first diagnostic facility when the GP did not suspect cancer or serious illness. Long distance was associated with higher probability of GP dissatisfaction with the waiting time for diagnostic investigations. [ABSTRACT FROM AUTHOR]