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Little is known about how unpaid family caregivers may already be engaged in caregiving activities prior to their care recipient's cancer diagnosis. We examined pre-cancer diagnosis caregiving patterns and their association with caregiving strain. We conducted a population-based analysis of 2011–2017 National Health and Aging Trends Study (NHATS) linked with the National Study of Caregiving (NSOC) and Medicare claims data. Latent class analysis was used to examine patterns of 16 health-focused caregiving tasks (e.g., tracking medications, making appointments) of family caregivers assisting adults ≥65 years prior to an incident cancer diagnosis. High caregiving strain was defined as a total score ≥ 85th percentile of 6 caregiving strain items (e.g., financial difficulty, no time for self). Association between caregiving patterns and strain were examined using multivariable logistic regression, adjusting for care recipient and caregiver characteristics. An estimated 4.2 million caregivers cared for older adults prior to care recipients' new cancer diagnoses during 2011–2017. They engaged in a median of four health-focused caregiving activities. Nearly 1-in-5 (18.7%) pre-cancer caregivers had high caregiving strain. Caregivers were classified into 3 health-focused caregiving activity classes: Low-level (41.2%), Moderate-coordination (29.3%), and High-intensity (29.4%). Higher caregiving activity was associated with higher caregiving strain (adjusted odds ratio (aOR) = 3.85, 95% CI: 2.34–6.33). Caregivers in the High-intensity class had the highest caregiving strain (39.9%), and included more spouses (28.1% vs <18%). One-third of U.S. caregivers who help older adults prior to their cancer diagnoses are already highly strained and engaged in high-level health-focused caregiving tasks. Oncology clinicians should assess the capacity and strain of family caregivers who may already be supporting patients with new cancer diagnoses and refer caregivers to additional supportive care services. [ABSTRACT FROM AUTHOR]

While public knowledge on the prevalence and adverse health effects of secondhand tobacco smoke exposure is well established, information on the prevalence of secondhand marijuana smoke (SHMS) exposure is limited. A convenience sample of parents of children attending 1 of 4 pediatric practices in the Mount Sinai Health System completed an anonymous questionnaire assessing demographics, housing characteristics, and the child's health status, as well as smoke incursions and household smoking behaviors. About 450 parents completed the survey between 2018 and 2019; those with incomplete data were excluded, and 382 surveys were included in the analysis. Approximately 40% of the children were white; the median age was 15 months (interquartile range: 5–40 months). About 30.9% (n = 118) of participants reported marijuana incursions in their home while with their child, while 33.5% (n = 122) reported tobacco smoke incursions. SHMS exposure differed by race (P =.0043); and by housing types (P <.0001). Participants in New York City Housing Authority (NYCHA) developments were more likely to report smelling SHMS (adjusted odds ratio = 3.45, 95% confidence interval = 1.18, 10.10], P =.02). Those in Section 8 housing were also more likely to report smelling SHMS, but the association was not significant (adjusted odds ratio = 3.29, 95% confidence interval = 0.94, 11.55, P =.06). Approximately two thirds of the participants reported viewing marijuana smoke as being harmful to their child. About one third of the families enrolled in the study reported smelling SHMS while at home with their child. Reported marijuana smoke exposure was associated with living in NYCHA housing. Policies that limit all smoke in multiunit housing should be supported. [ABSTRACT FROM AUTHOR]

As cancer trajectories change due to screening, earlier diagnoses, living longer with illnesses, and new successful treatments, cancer is increasingly a disease of older adults. While cancer diagnoses themselves are very stressful for patients and families, little is known about the health status, functional limitations, and social resources of older patients before they face a new cancer diagnosis. Using the National Health and Aging Trends Study (NHATS), a national survey of older Medicare beneficiaries linked to Medicare claims data, we examined the health characteristics, functional limitations and social and financial resources of older adults before a new diagnosis of lung, breast, prostate or colorectal cancer and how these factors vary by race/ethnicity. We identified 274 community-dwelling older adults with incident cancer diagnoses: lung (30.6%), breast (20.3%), prostate (30.8%), and colorectal (18.3%) representing 1,202,920 older Medicare beneficiaries. The sample was 81% Non-Hispanic White, 10% Non-Hispanic Black, and 9% Hispanic/Other. Before diagnosis, patients had an average of three comorbidities and 29% of patients reported poor/fair health. Almost one-third were living alone, 13% received help with at least one activity of daily living (ADL), 11% had probable dementia and nearly one in ten already received financial help from family members. Before an older adult has ever been diagnosed with a major cancer, many face significant health and financial challenges and are dependent on others for care. These needs vary based on cancer type and race/ethnicity and must be considered as clinicians develop individualized care plans for patients alongside caregivers. [ABSTRACT FROM AUTHOR]

Background There are no published reports on predictors of oxygen (O 2) use after lung cancer surgery. The prospect of O 2 use after lung cancer surgery may affect a patient's therapy choice. Methods The Surveillance, Epidemiology, and End Results (SEER)-Medicare data set was queried to identify patients diagnosed with primary lung cancer (stage I/II) who underwent surgical resection from 1994 to 2010. Patients with a second resection within 6 months of their first and those with preoperative O 2 use were excluded. Multivariable logistic regression was performed to evaluate the odds ratios and 95% confidence intervals of O 2 use (defined as being billed for home O 2) after discharge for lung cancer surgery. Results Of 21,245 eligible patients from 1994 to 2010, 3,255 (15.3%) were billed for O 2 use in the first month of discharge. Of these, 13.7% (447 of 3,255) stopped using within 1 month, and 1.47% died. By 6 months, an additional 6.7% died, and 46.27% (1,384 of 2,991) were still alive and using O 2. Discharge on O 2 was associated with higher odds of death within 6 months (odds ratio, 1.35; 95% confidence interval, 1.17 to 1.55). The significant, independent risk factors for O 2 use at discharge were procedure, sex, race, histology, pulmonary comorbidities, obesity, length of stay, pulmonary complications, and discharge mode. Conclusions Home O 2 use after lung cancer surgery comprises a sizable portion of this population and is correlated with death in the first 6 months. Various predictors significantly increased the risk of O 2 use at discharge. However, 49.3% of those originally discharged on O 2 were alive and off O 2 at 6 months. [ABSTRACT FROM AUTHOR]

Background Utilization of high-volume hospitals (HVH) for esophagectomy has been associated with improved perioperative outcomes and reduced mortality. We aimed to test the hypothesis that black-white racial disparities exist in HVH utilization and identify predictors of in-hospital surgical outcomes of esophageal cancer while adjusting for HVH utilization patterns. Methods We queried the New York Statewide Planning and Research Cooperative System database (1995 to 2012) for esophageal cancer patients who underwent surgical resection exclusively. Only records for patients with self-reported white or black race and a valid New York State ZIP code were included (n = 2,895). Analysis was performed to identify factors associated with HVH hospital (≥20 esophagectomies/year) utilization and determine predictors of complications and in-hospital mortality. Results Black patients (361 [12.5%]) were significantly different ( p < 0.001) than their white counterparts in the proportion of women, Medicaid, income distribution, and privately insured individuals. Although 55% patients overall utilized an HVH, blacks were significantly less likely to utilize an HVH than whites (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.14 to 0.24), even though 74.5% resided within 8.9 miles of one. Operations performed at HVHs were associated with lower in-hospital mortality (OR, 0.48; 95% CI, 0.35 to 0.65); however, mortality remained higher for blacks (OR, 2.04; 95% CI, 1.65 to 3.30; propensity matched OR, 2.45; 95% CI, 1.5 to 4.03). Conclusions Black patients were less likely to undergo esophagectomy at an HVH and experienced higher mortality. Efforts should be made to understand factors influencing patients’ decision process and improve referral practices to ensure optimal care is provided across all segments of the population, irrespective of race, insurance, or income status. [ABSTRACT FROM AUTHOR]

Background Mediastinal lymph node evaluation (MLNE) is considered to be the standard of care in curative lung cancer surgery although it is not always performed. This study identifies factors associated with patients not being evaluated (non-MLNE) in cases of resectable non-small cell lung cancer. Methods A retrospective observational study using the Surveillance, Epidemiology, and End Results Program database was conducted. Adult patients diagnosed with non-small cell lung cancer stage I to IIIA (2004 to 2013) were included. Multilevel logistic regression analysis was performed to identify factors that were associated with non-MLNE. Results There were 86,721 patients included in this study: 73,034 (84.2%) with MLNE and 13,687 (15.8%) without. The use of MLNE gradually increased from 82.7% in 2004 to 85.8% in 2013. In multivariable analysis, factors associated with non-MLNE included the following: age more than 75 years (adjusted odds ratio [OR adj ] 1.20, 95% confidence interval [CI]: 1.13 to 1.27); black (OR adj 1.11, 95% CI: 1.32 to 1.20); Native American/Alaskan (OR adj 1.63, 95% CI: 1.15 to 2.31); uninsured (OR adj 1.28, 95% CI: 1.05 to 1.56); residing in a low-income county (OR adj 1.12, 95% CI: 1.04 to 1.21); lesion at the middle lobe (OR adj 1.42, 95% CI: 1.29 to 1.56); lower lobe (OR adj 1.06, 95% CI: 1.01 to 1.11) or main bronchus (OR adj 2.38, 95% CI: 1.93 to 2.94); stage IA (OR adj 1.24, 95% CI: 1.17 to 1.32); sublobar resection (OR adj 11.08, 95% CI: 11.30 to 12.33); and preoperative treatment (OR adj 1.21, 95% CI: 1.08 to 1.36). Non-MLNE was less likely to occur in patients with adenocarcinoma (OR adj 0.88, 95% CI: 0.83 to 0.92) and more likely in other cell types (OR adj 1.23, 95% CI: 1.15 to 1.32), compared with squamous cell carcinoma. Conclusions Patient demographics and socioeconomic status are associated with the decision to perform MLNE. Thoracic surgeons should access these factors and perform MLNE to accurately determine tumor stage and improve survival. [ABSTRACT FROM AUTHOR]

Background Studies reporting the benefits of video-assisted thoracoscopic surgery (VATS) lung cancer resection over thoracotomy have been subject to selection bias. We evaluated patient and hospital characteristics associated with type of surgery and the independent effect of VATS on outcomes. Methods The Statewide Planning and Research Cooperative System of New York State database was queried to identify all lung cancer patients undergoing lobectomy or sublobar resection between 2007 and 2012. Multivariable logistic regression was performed to identify patient (age, sex, race, comorbidities, year, and insurance) and hospital (urban, teaching, and total lung surgery volume) cofactors associated with surgical technique and propensity scores were used to evaluate whether technique was independently associated with complications or in-hospital mortality. Results There were 5,505 lobectomy and 4,282 sublobar resection patients, with 2,318 (42%) and 2,416 (56%) undergoing VATS, respectively. For lobectomy, VATS was associated with being female, lower comorbidity index, private insurance, older age, surgery in recent year, nonteaching hospital, and higher annual lung surgery volume. For sublobar resection, VATS was associated with black race, lower comorbidity index, Medicaid or other insurance, surgery in recent year, rural hospital, and higher annual lung surgery volume. Complication rate was significantly lower for VATS lobectomy and not sublobar resection, whereas in-hospital mortality was lower for VATS in both resection groups. Conclusions Numerous patient- and hospital-related variables that affect morbidity and mortality also affect whether a patient undergoes VATS or open lung resection. Studies evaluating VATS must account more accurately for selection bias and adjust for these confounders. [ABSTRACT FROM AUTHOR]

Background The relationship between margin distance and recurrence and survival for stage I non-small cell lung carcinoma (NSCLC) less than or equal to 2 cm is not clear. Methods Patient clinicopathologic data were reviewed from a pooled data set of stage I NSCLC lesions less than or equal to 2 cm resected by wedge resection at Brigham and Women's Hospital (BWH) between 2000 and 2005 and the International Early Lung and Cardiac Action Program (I-ELCAP) between 1999 and 2015. Multivariable models were constructed to evaluate the relationship between margin distance and recurrence and survival, adjusting for patient age, sex, tumor size, and histologic type. Optimal margin distance was determined for recurrence-free and overall survival using maximum χ 2 values among survival distributions. Results Of 182 cases, 138 tumors had margin distance reported (113 BWH and 25 I-ELCAP). The average tumor size was 13.3 mm, and margin distance was 8.3 mm. During a mean follow-up of 49.6 months, there were 33 recurrences and 59 deaths. Increased margin distance was independently associated with lower risk of recurrence (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.83–0.98). Margin distance was also independently associated with longer survival (hazard ratio [HR], 0.94; 95% CI, 0.90–0.98). A margin distance greater than 9 mm was associated with longest recurrence-free survival and a margin distance greater than 11 mm was associated with longest overall survival. Conclusions Increased margin distance was independently associated with lower risk of recurrence and longer overall survival in patients undergoing wedge resection for NSCLC tumors less than or equal to 2 cm. These findings suggest that with a minimum appropriate margin distance, wedge resection may yield outcomes comparable to those of lobectomy. [ABSTRACT FROM AUTHOR]

Polycyclic aromatic hydrocarbons (PAHs) are a category of over 100 various chemicals released from numerous combustion sources. The ubiquity and toxicity of PAHs have posed high health risks on human populations. This study aims to examine the long-term trends of atmospheric PAHs at the national-level in the U.S., and evaluate their cancer risks. Daily concentrations of PAHs measured at 169 monitoring stations between 1990 and 2014 were obtained from the U.S. Environmental Protection Agency's Air Quality System. Temporal trends were examined using generalized linear model with generalized estimating equations. Random-effects analysis of variance was performed to explore variance between regions, sites, years, and months with a hierarchical structure. Source categories were identified using diagnostic ratios. National population level cancer risks were estimated using the relative potency factors and inhalation unit risk method. Ambient PAH concentrations displayed an overall downward trend (6–9% annual reduction) in urban areas, but not in rural areas. Seasonal and weekday/weekend effects were significant. Urban concentrations were twice of the rural level. The between-site variation outweighed the temporal variation, indicating large spatial heterogeneity. The predominant PAH sources were from traffic and non-traffic related fuel combustions with a dominant contribution from diesel emissions. The average excess lifetime cancer risk was estimated to be 9.3 ± 30.1 × 10 −6 (GM: 4.2 × 10 −6 ) from exposure to ten carcinogenic PAHs. This is the first comprehensive study of the spatiotemporal trends of ambient PAHs at the U.S. national level. The results indicate that future efforts aimed to reduce PAH exposures should focus on diesel emission controls and extending the geographic coverage of air monitoring. [ABSTRACT FROM AUTHOR]

Background A systematic review of the literature was performed to compare long-term outcomes of thymectomy and medical treatment for generalized myasthenia gravis (MG). Methods A Medline search through June 2015 resulted in 71 studies, 27 of which were selected (10,140 patients: 5,275 thymectomies, 4,865 medication). Results The pooled proportion of remission with thymectomy was 0.31 (95% CI, 0.25–0.37), with conservative treatment it was 0.15 (95% CI, 0.12–0.18). The odds ratio (OR) of remission with thymectomy in comparison with medication alone was 2.44 (95% CI, 1.91–3.12) overall and according to medication type and remission definitions. Conclusions Thymectomy is superior to conservative treatment with solely medication on remission in MG. [ABSTRACT FROM AUTHOR]

Background and Objective: Elevated alkaline phosphatase (ALP) is considered as a marker of liver function in clinical practice. Furthermore, it has been identified that liver function can contribute to hemorrhagic transformation (HT). However, whether ALP levels play a role in HT after stroke remains an open question, especially in cardioembolic stroke patients.Methods: We prospectively and consecutively enrolled ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. Baseline data including ALP levels within 48 hours after admission were collected. ALP levels were divided into tertiles. The presence of HT, hemorrhagic infarction (HI), parenchymal hematoma (PH), and symptomatic HT was evaluated according to brain magnetic resonance imaging and European-Australasian Acute Stroke Study III definitions. We used logistic regression to examine the associations between ALP levels and risk of HT, HI, PH, and symptomatic HT.Results: Of the 130 patients (56 male; mean age: 63 years) included finally, 50 (38.5%) developed HT and 13 (10.0%) developed symptomatic HT. ALP levels were not associated with risk of HT, HI, and PH. However, compared with the first ALP tertile, patients in the third tertile were 8.96 times more likely to have symptomatic HT (95% confidence interval: 1.33-60.21; P = .02) after adjusting for age, gender, alanine aminotransferase levels, aspartate aminotransferase levels, antiplatelet therapy, anticoagulation therapy, and thrombolysis therapy.Conclusion: Elevated ALP levels may help identify high-risk symptomatic HT in ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. However, further studies with larger cohorts are needed to identify our results. [ABSTRACT FROM AUTHOR]

Home-based medical care (HBMC) delivers physician or advanced practice provider–led medical services for patients in private residences and domiciliary settings (eg, assisted living facilities, group/boarding homes). We aimed to examine the time trends in HBMC utilization by care settings. Analyses of HBMC utilization at the national and state levels during the years 2012–2019. With Medicare public use files, we calculated the state-level utilization rate of HBMC among fee-for-service (FFS) Medicare beneficiaries, measured by visits per 1000 FFS enrollees, in private residences and domiciliary settings, both separately and combined. We assessed the trend of HBMC utilization over time via linear mixed models with random intercept for state, adjusting for the following state-level markers of HBMC supply and demand: number of HBMC providers, state ranking of total assisted living and residential care capacity, and the proportion of FFS beneficiaries with dementia, dual eligibility for Medicaid, receiving home health services, and Medicare Advantage. Total HBMC visits in the United States increased from 3,911,778 in 2012 to 5,524,939 in 2019. The median (interquartile range) state-level HBMC utilization rate per 1000 FFS population was 67.6 (34.1–151.3) visits overall, 17.3 (7.9–41.9) visits in private residences, and 47.7 (23.1–86.6) visits in domiciliary settings. The annual percentage increase of utilization rates was significant for all care settings in crude models (3%–8%), and remained significant for overall visits and visits in domiciliary settings (2%–4%), but not in private residences. The national-level growth in HBMC from 2012–2019 was largely driven by a growth of HBMC occurring in domiciliary settings. To meet the needs of a growing aging population, future studies should focus efforts on policy and payment issues to address inequities in access to HBMC services for homebound older adults, and examine drivers of HBMC growth at regional and local levels. [ABSTRACT FROM AUTHOR]

• Determinants of neighborhood-level cancer risks are less well-understood. • We developed a new large-scale neighborhood dataset for all US census tracts. • We used a novel machine learning approach to select correlates of cancer prevalence. • We investigated correlates from four major domains of the neighborhood environment. • We found key demographic, healthcare access, and environmental predictors of cancer prevalence. Preventive measures, health behaviors, environmental exposures, and sociodemographic characteristics affect individual-level cancer risks. It is unclear how they influence neighborhood-level cancer risks. We developed a large-scale neighborhood health dataset for 72,337 census tracts in the United States by combining data from three publicly available sources. We used Bayesian additive regression trees to identify the most important predictors of tract-level cancer prevalence among adults (age ≥18 years), and examined their impact on cancer prevalence using partial dependence plots. The five most important census tract-level correlates of cancer prevalence were the proportion of population who were aged 65 years and older, had routine checkup and were non-Hispanic White, the proportion of houses built before 1960, and the proportion of population living below the poverty line. The identified predictors of neighborhood-level cancer prevalence may inform public health practitioners and policymakers to prioritize the improvement of environmental and neighborhood factors in reducing the cancer burden. [ABSTRACT FROM AUTHOR]

1. Describe how providers who participated in the same goals-of-care discussion view elements of that discussion 2. Describe potential implications of provider concordance or lack of concordance during difficult conversations and potential relationship to communication quality Little is known about concordance of neonatal intensive care unit (NICU) provider perspectives regarding goals-of-care (GOC) discussions. To explore concordance of provider perspectives in relation to GOC discussions in which they took part. Prospective cohort study in a level IV NICU in an urban teaching hospital. We administered a validated instrument (the Williams Instrument, a measure of end-of-life care) following GOC to physicians, nurses, and social workers. We assessed the simple percentage agreement of the responses for each Williams Instrument item among participants from the same GOC discussion. We collected data on 79 GOC conversations over a 1-year period from 2018 to 2019. We found that scores on the Williams Instrument within a discussion were moderately concordant with a median Kendall's correlation coefficient of 0.40 (interquartile range, 0.32-0.48; minimum-maximum, 0.17-0.65, n = 79). The percentage of individuals who participated in the same conversation who agreed about presence or absence of an item in that conversation differed between items on the Williams Instrument. Fourteen percent of items demonstrated low concordance and 20% demonstrated high concordance. There were high levels of agreement relating to whether providers were frank and honest, polite, respectful; and whether parents were encouraged to ask questions or whether providers avoided answering questions. We found that providers who participated in the same GOC conversation demonstrated moderate concordance with each other about that conversation. This finding is important to future study of communication around difficult topics because it suggests some potential for objectivity surrounding components of GOC discussions. Staff perceptions of GOC conversations and the degree to which these perceptions are concordant with those of other providers' perceptions may provide useful insight into communication quality. The items upon which providers disagree may represent key elements that warrant further study and targeting with future interventions. [ABSTRACT FROM AUTHOR]

Abstract: Rationale: Previously we reported that airborne concentrations of cis-permethrin, but not trans-permethrin, measured during pregnancy in an inner city pediatric cohort was associated with cough by age 5. However, the effect of subsequent exposures to both permethrins during early childhood, and to piperonyl butoxide (PBO, a synergist for residential pyrethroid insecticides) remains to be elucidated. We hypothesized that prenatal and age 5–6year measures of PBO and permethrins would be associated with cough at age 5–6years in this cohort. Further, we explored the associations between these pesticide measures and wheeze, asthma, seroatopy, and fractional exhaled nitric oxide (FeNO). Methods: PBO and permethrins were measured in personal air during the third trimester of pregnancy and indoor residential air at age 5–6years (n=224). Health outcome questionnaires were administered to the mothers of 5–6year old children. Indoor allergen specific and total immunoglobulin (Ig) E production was measured from sera collected at age 5, and FeNO was measured at 5–6years. The hypotheses were tested using regression models adjusting for common confounders. Results: Noninfectious cough was reported among 14% of children at age 5–6years. Measures of prenatal PBO, but not age 5–6year PBO or permethrins, increased the odds of cough [OR (95% CI): 1.27 (1.09–1.48), p<0.01; n=217]. No significant associations were found for other measured health outcomes. Conclusions: Prenatal PBO exposure was associated with childhood cough. It is unclear whether the observed effect is due mainly to PBO itself or residential pyrethroids of which PBO is an indicator. [Copyright &y& Elsevier]

We examined Hg biogeochemistry in Baihua Reservoir, a system affected by industrial wastewater containing mercury (Hg). As expected, we found high levels of total Hg (THg, 664–7421 ng g−1) and monomethylmercury (MMHg, 3–21 ng g−1) in the surface sediments (0–10 cm). In the water column, both THg and MMHg showed strong vertical variations with higher concentrations in the anoxic layer (>4m) than in the oxic layer (0–4 m), which was most pronounced for the dissolved MMHg (p < 0.001). However, mercury levels in biota samples (mostly cyprinid fish) were one order of magnitude lower than common regulatory values (i.e. 0.3–0.5 mg kg−1) for human consumption. We identified three main reasons to explain the low fish Hg bioaccumulation: disconnection of the aquatic food web from the high MMHg zone, simple food web structures, and biodilution effect at the base of the food chain in this eutrophic reservoir. [Copyright &y& Elsevier]

Abstract: Measurements of gaseous elemental mercury (GEM), particulate mercury (Hgp), and reactive gaseous mercury (RGM) were concurrently recorded at an urban site in Detroit and a rural site in Dexter, both in Michigan for the calendar year 2004. Their average concentrations (±standard deviation) for the urban area were 2.5 ± 1.4 ng m−3, 18.1 ± 61.0 pg m−3, and 15.5 ± 54.9 pg m−3, respectively, while their rural counterparts were 1.6 ± 0.6 ng m−3, 6.1 ± 5.5 pg m−3, and 3.8 ± 6.6 pg m−3, respectively. The medians of urban-to-rural ratios of Hg concentrations indicate approximately 1-fold, 2-fold, and 3-fold gradients between Detroit and Dexter for GEM, Hgp, and RGM, respectively. The urban–rural differences in Hg also varied considerably on different temporal scales and with wind flow patterns, which was most evident in RGM. Our results show that while Hg at both sites was impacted by regional sources, meteorological conditions, and photochemical transformations, the extent of variations in the observed urban-to-rural gradients, particularly in RGM, cannot be fully accounted for by these processes. Both analyses of the annual data and case studies indicate that the more variable and episodic nature of Hg, particularly RGM, seen in Detroit compared with Dexter, was the result of direct impact from local anthropogenic sources. [Copyright &y& Elsevier]

Semi-continuous measurements of ambient mercury (Hg) species were performed in Detroit, MI, USA for the calendar year 2003. The mean (±standard deviation) concentrations for gaseous elemental mercury (GEM), particulate mercury (HgP), and reactive gaseous mercury (RGM) were 2. 2±1. 3ngm−3, 20. 8±30. 0, and 17. 7±28. 9pgm−3, respectively. A clear seasonality in Hg speciation was observed with GEM and RGM concentrations significantly (p<0. 001) greater in warm seasons, while HgP concentrations were greater in cold seasons. The three measured Hg species also exhibited clear diurnal trends which were particularly evident during the summer months. Higher RGM concentrations were observed during the day than at night. Hourly HgP and GEM concentrations exhibited a similar diurnal pattern with both being inversely correlated with RGM. Multivariate analysis coupled with conditional probability function analysis revealed the conditions associated with high Hg concentration episodes, and identified the inter-correlations between speciated Hg concentrations, three common urban air pollutants (sulfur dioxide, ozone, and nitric oxides), and meteorological parameters. This analysis suggests that both local and regional sources were major factors contributing to the observed temporal variations in Hg speciation. Boundary layer dynamics and the seasonal meteorological conditions, including temperature and moisture content, were also important factors affecting Hg variability. [Copyright &y& Elsevier]

Summary socioeconomic indexes that capture information about wealth, education, employment, and housing are in wide use in public health. Here we compare the widely used Area Deprivation Index (ADI) to the Yost index. Though they are derived largely from the same data, there are substantial differences between the two. Examination of the geographic areas where the two indexes are most dissimilar suggest that the Yost index has greater face validity and that the ADI is highly sensitive to locations with incomplete census data and with census data containing outliers. [ABSTRACT FROM AUTHOR]

Context: Given a shortage of specialty palliative care clinicians and geographic variation in availability, telemedicine has been proposed as one way to improve access to palliative care services for patients with cancer. However, the enduring digital divide raises questions about whether unequal access will exacerbate healthcare disparities.Objectives: To examine factors associated with utilization of telemedicine as compared to in-person visits by patients with cancer in the ambulatory palliative care setting.Methods: We collected data on patients seen in Supportive Oncology clinic by palliative care clinicians with an in-person or telemedicine visit from March 1 to December 30, 2020. A logistic regression with generalized estimating equation was fit to assess the association between visit type and patient characteristics.Results: A total of 491 patients and 1783 visits were identified, including 1061 (60%) in-person visits and 722 (40%) telemedicine visits. Female patients were significantly more likely to utilize telemedicine than male patients (OR 1.46; 95% CI 1.11-1.90). Spanish-speaking patients (OR 0.32, 95% CI 0.17-0.61), those without insurance (OR 0.28, 95% CI 0.15-0.52), and those without an activated patient portal (Inactivated: OR 0.46, 95% CI 0.26-0.82; Pending Activation: OR 0.29, 95% CI 0.18-0.48) were less likely to utilize telemedicine.Conclusion: Our study reveals disparities in telemedicine utilization in the ambulatory palliative care setting for patients with cancer who are male, Spanish-speaking, uninsured, or do not have an activated patient portal. In the wake of the COVID-19 pandemic, we can better meet the palliative care needs of patients with cancer through telemedicine only if equity is kept at the forefront of our discussions. [ABSTRACT FROM AUTHOR]

Abstract Objective Although the incidence of lung cancer has decreased over the past decades, disparities in survival and treatment modalities have been observed for black and white patients with early-stage non–small cell lung cancer, despite the fact that surgical resection has been established as the standard of care. Possible contributors to these disparities are stage at diagnosis, comorbidities, socioeconomic factors, and patient preference. This study examines racial disparities in treatment, adjusting for clinicodemographic factors. Methods The Surveillance, Epidemiology, and End Results-Medicare dataset was queried to identify patients diagnosed with primary stage I non–small cell lung cancer between 1992 and 2009. Multivariable logistic regressions were performed to assess the association between race and treatment modalities within 1 year of diagnosis, adjusted for clinical and demographic factors. Adjusted Cox proportional hazards models were performed to evaluate disparities in survival, accounting for mode of treatment. Results We identified 22,724 patients; 21,230 (93.4%) white and 1494 (6.6%) black. Black patients were less likely to receive treatment (odds ratio [OR] adj , 0.62; 95% confidence interval [CI], 0.53-0.73) and less likely to receive surgery only when treated (OR adj , 0.70, 95% CI, 0.61-0.79). Although univariate survival for black patients was worse, when accounting for treatment mode, there was no difference in survival (hazard ratio adj , 0.97; 95% CI, 0.90-1.04 for all patients, hazard ratio adj , 0.98; 95% CI: 0.90-1.06 for treated patients). Conclusions Treatment disparities persist, even when adjusting for clinical and demographic factors. However, when black patients receive similar treatment, survival is comparable with white patients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research.Methods: Electronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list.Results: Among the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP.Conclusions: Existing economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation. [ABSTRACT FROM AUTHOR]

Objectives: To identify and characterize the constellation, or clusters, of self-management behaviors in patients with chronic obstructive pulmonary disease (COPD) and comorbid hypertension.Methods: Cluster analysis (n = 204) was performed with standardized scores for medication adherence to COPD and hypertension medications, inhaler technique, and diet as well as self-reported information on physical activity, appointment keeping, smoking status, and yearly influenza vaccination for a total of eight variables. Classification and regression tree analysis (CART) was performed to further characterize the resulting clusters.Results: Patients were divided into three clusters based on eight self-management behaviors, which included 95 patients in cluster 1, 42 in cluster 2, and 67 in cluster 3. All behaviors except for inhaler technique differed significantly among the three clusters (P's<0.005). CART indicated physical activity was the first differentiating variable.Conclusions: Patients with COPD and hypertensioncan be separated into those with adequate and inadequate adherence. The group with inadequate adherence can further be divided into those with poor adherence to medical behaviors compared to those with poor adherence to lifestyle behaviors.Practice Implications: Once validated in other populations, the identification of patient clusters using patient self-management behaviors could be used to inform interventions for patients with multimorbidity. [ABSTRACT FROM AUTHOR]

A growing proportion of Medicare home health (HH) patients are "community-entry," meaning referred to HH without a preceding hospitalization. We sought to identify factors that predict community-entry HH use among older adults to provide foundational information regarding care needs and circumstances that may prompt community-entry HH referral. Nationally representative cohort study. Health and Retirement Study (HRS) respondents who were aged ≥65 years, community-living, and enrolled in Medicare between 2012 and 2018 (n = 11,425 unique individuals providing 27,026 two-year observation periods). HRS data were linked with standardized HH patient assessments. Community-entry HH utilization was defined as incurring one or more HH episode with no preceding hospitalization or institutional post-acute care stay (determined via assessment item indicating institutional care within 14 days of HH admission) within 2 years of HRS interview. Weighted, multivariable logistic regression was used to model community-entry HH use as a function of individual, social support, and community characteristics. The overall rate of community-entry HH utilization across observation periods was 13.4%. Older adults had higher odds of community-entry HH use if they were Medicaid enrolled [adjusted odds ratio (aOR) = 1.49, P =.001], had fair or poor overall health (aOR = 1.48, P <.001), 3+ activities of daily living limitations (aOR = 1.47, P =.007), and had fallen in the past 2 years (aOR = 1.43, P <.001). Compared with those receiving no caregiver help, individuals were more likely to use community-entry HH if they received family or unpaid help only (aOR = 1.81, P <.001), both family and paid help (aOR = 2.79, P <.001), or paid help only (aOR: 3.46, P <.001). Findings indicate that community-entry HH serves a population with long-term care needs and coexisting clinical complexity, making this an important setting to provide skilled care and prevent avoidable health care utilization. Results highlight the need for ongoing monitoring of community-entry HH accessibility as this service is a key component of home-based care for a high-need subpopulation. [ABSTRACT FROM AUTHOR]

• A new acidic grouting material was prepared with sodium silicate and phosphoric acid. • Properties of the acidic grouting material were studied. • Orthogonal test was used to optimize the ratio of sodium silicate and phosphoric acid. • Meso-scopic mechanism of the grouting reinforcement of the acidic grouting material was investigated. Slurry selection and ratio optimization are the key points and difficulties in the construction of subway tunnels in poorly graded medium sand strata. In this paper, a kind of acidic grouting material was prepared by using sodium silicate and phosphoric acid. The properties of the acidic grouting material including gel time and viscosity were studied. Orthogonal test was carried out to optimize the ratio of sodium silicate to phosphoric acid for poorly graded sand stratum. At the same time, X-ray diffraction (XRD) and scanning electron microscope (SEM) were used to analyze the sand consolidation process of the slurry. The results show that the gel time and funnel viscosity of the phosphoric acid-sodium silicate slurry are related to the Baume degree of sodium silicate and the volume ratio of sodium silicate to phosphoric acid. The compressive strength of the grouted sand is related to four factors, i.e., water content of the sand, and Baume degree, pH value and curing time of the slurry, the influence degree of which is in the following order: D (curing time) > A (water content) > B (Baume degree of sodium silicate) > C (pH value of the slurry). The final slurry selected for grouting reinforcement of the weakly alkaline medium sand strata was prepared by 30 °Bé sodium silicate with 14 % phosphoric acid at a volume ratio of 0.5. It has a gel time of 51.48 min, a funnel viscosity of 16.43 s and a pH value of 3.47. The increased amount of silica gel in the sample is the main reason for the increased strength of the grouted sand. The amount of silica gel generated increases with the increase of the curing time of the sample. [ABSTRACT FROM AUTHOR]

Background Patterns of intracerebral hemorrhage (ICH) and outcomes in Tibetans are poorly understood. We aimed to investigate the long-term outcomes of Tibetan ICH patients. Methods This prospective study involved a consecutive series of ICH patients admitted within 1 month of onset to West China Hospital (WCH) on the Chengdu Plain or People's Hospital of Garzê (PHG) on the Tibetan Plateau between January 2013 and December 2013. Basic characteristics and functional outcomes were compared between PHG and WCH groups. Results Of the 843 cases included, 105 (12.5%) were from PHG and 738 (87.5%) were from WCH. Compared with patients from WCH, patients from PHG were older and had higher blood pressure on admission, and a greater proportion had hypertension (all P < 0.001). Among patients from PHG, the 1-year death rate was 30.5%, similar to that in WCH ( P = 0.987), and the adjusted 3-month disability risk was 2.0-fold higher than for WCH patients, while the adjusted 1-year disability risk was 2.5-fold higher than for WCH patients (both P ≤ 0.05). The adjusted 3-month risk of disability/death was 2.1-fold higher in PHG patients than in WCH patients, while the adjusted 1-year risk was 2.4-fold higher (both P ≤ 0.05). Conclusions Most cases of ICH on the Tibetan Plateau involve concomitant hypertension. Tibetan patients are at higher risk of disability or disability/death on follow-up than are patients from Chengdu Plain. [ABSTRACT FROM AUTHOR]