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This paper examines the spatial, environmental, and temporal patterns of 10,488 stranger rapes committed over a 15-year period in Greater London, UK. We distinguished between two types of stranger rapes according to perpetrator method of approach, i.e. absent/fleeting interaction with victim on approach (S1) or extended interaction with victim on approach (S2). There were a range of locational settings in which perpetrators both encountered their victims and where the offence took place, and these differed by method of approach. The highest number of S1 offences occurred outdoors, with 74% of approaches and 55% of offences located recorded as outside. For S2 rapes, there was more variety in approach locations with only 32% outside. The level of locational correspondence between approach and offence location was 71% for S1 rapes and 28% for S2 rapes. A series of negative binomial regression models identified variables predictive of stranger rape offence location. There were significant associations with transport connections and the night-time economy for both S1 and S2 rapes. Other significant predictors were deprivation score, the percentage of one person properties, and the percentage of private rented properties in a location. The percentage of green space was a significant predictor for S1 rapes only. The current findings challenge the popular narrative that stranger rape occurs in a specific setting (i.e. outside in a secluded location at night) and have implications for place-based crime prevention policy. [ABSTRACT FROM AUTHOR]

This Special Issue is a collection of seven papers that seek to better our understanding of how urban mobility relates to crime patterns, and how day to day movement of people in urban spaces (urban mobility) is related to spatio-temporal patterns of crime. It focusses on urban mobility, or the dynamic movement of people in relation to crime risk. Moreover, it questions how to best measure this risk using an appropriate crime denominator. Building on the work of Sarah Boggs, this special issue contends that we need more than an appropriate denominator related to the type of crime we are measuring, for example violence based on the number of potential victims present (the exposed or ambient population), or the number of burglaries per households in an area, or the number of shoplifting offences per number of shops present. It argues that this denominator needs to be both 'crime type' appropriate, and to be spatially and temporally appropriate. When considering urban mobility as flows of people, the challenge is that the denominator can not be considered as a fixed or static concept, and that we need to consider the 'dynamic denominator' challenge. Indeed, crime hot spots which do not account for dynamic denominators may be misleading for resource prioritisation. This special issue explores a range of potential solutions to this including mobile/cell phone data, transportation data, land use data, and other possible measures to address this. [ABSTRACT FROM AUTHOR]

Purpose: Current methods of assessing disease burden in gastric adenocarcinoma are imperfect. Improved visualization during surgery with intraoperative molecular imaging (IMI) could improve gastric adenocarcinoma staging and guide surgical decision-making. The goal of this study was to evaluate if IMI with a folate receptor-targeted near-infrared fluorescent agent, OTL38, could identify gastric adenocarcinomas during surgery. Procedures: Five patients were enrolled in an IMI clinical trial. Patients received a folate receptor-targeted near-infrared dye (OTL38) 1.5–6 h prior to surgery. During staging laparoscopy and gastric resection, IMI was utilized to identify the primary tumor and any fluorescent lymph nodes. Resected tumors were analyzed for folate receptor alpha (FRα) and CD68 expression using immunohistochemistry. Microscopic OTL38 accumulation was examined with immunofluorescence. Results: Four out of five patients underwent total or subtotal gastrectomy; one had a staging laparoscopy only. All four patients who underwent gastric resection had invasive gastric adenocarcinoma; three had fluorescent tumors, mean tumor to background ratio (TBR) 4.1 ± 2.9. The one patient with a non-fluorescent tumor had a T1a tumor with two 0.4 cm tumor foci within a larger polyp. In each case with a fluorescent tumor, the fluorescence was evident from the exterior of the stomach. Two of the fluorescent tumors had modest FRα expression and no CD68 expression. One fluorescent tumor had high CD68 expression and no FRα expression. Conclusions: Intraoperative molecular imaging of gastric adenocarcinoma with OTL38 is feasible. Further studies should evaluate the clinical utility of this technique. [ABSTRACT FROM AUTHOR]

Purpose: Intraoperative molecular imaging (IMI) utilizes optical dyes that accumulate within tumors to assist with detection during a cancer operation. IMI can detect disease not visualized preoperatively, as well as positive margins. However, these dyes are limited by autofluorescence, signal reflection, and photon-scatter. We hypothesize that a novel dye with a wide separation between excitation and emission spectra, SS180, would help overcome these obstacles.Procedures: Two targeted molecular contrast agents, OTL38 and SS180, were selected for this study. Both dyes had the same targeting ligand to folate receptor alpha (FRα). OTL38, a well-annotated IMI agent in human trials, has a Stokes shift of 22 nm, whereas SS180, the new dye, has a Stokes shift of 129 nm. Cell lines were tested for FRα expression and incubated with dyes to demonstrate receptor-dependent binding. Cells were incubated in various concentrations of the dyes to compare dose- and time-dependent binding. Finally, cells tagged with the dyes were injected subcutaneously in a murine model to estimate tumor burden necessary to generate fluorescent signal.Results: Cellular studies demonstrated that SS180 binds cells in a dose-, receptor-, and time-dependent manner and exhibits higher mean fluorescence intensities by flow cytometry when compared with OTL38 for each time point and concentration. In an in vivo flank tumor model, SS180 had a higher tumor-to-background ratio (TBR) than OTL38, though not statistically significant (p = 0.08). Ex vivo, OTL38 had a higher TBR than SS180 (p = 0.02). The subcutaneous model revealed that SS180 had a higher TBR at 5 × 106 cells than OTL38 (p = 0.05). No toxicity was observed in the animals.Conclusions: SS180 exhibits greater TBRs in vivo, but not ex vivo. These findings suggest that SS180 may have weaker fluorescence, but superior contrast. Studies in large animal models and clinical trials may better elucidate the clinical value of a long Stokes shift. [ABSTRACT FROM AUTHOR]

Purpose: Intraoperative molecular imaging (IMI) is an emerging technology used to locate pulmonary adenocarcinomas and identify positive margins during surgery. Background noise and tissue autofluorescence have been major obstacles. The goal of this study is to optimize the image quality of folate receptor alpha (FRα) targeted IMI for pulmonary adenocarcinomas by modifying emission data.Procedures: A total of 15 lung cancer patients were enrolled in a pilot study. In the first cohort, FRα upregulation within pulmonary adenocarcinoma tumors was confirmed by analyzing specimens from five pulmonary adenocarcinoma patients with flow cytometry and immunohistochemistry. Next, in a cohort of five additional patients, autofluorescence of intrathoracic structures and tissues was quantified. Lastly, five patients with tumors at various depths from the pleural surface were enrolled and received the FRα-targeted optical contrast agent, EC17. In this final cohort, resected pulmonary adenocarcinomas were imaged at a wide range of fluorescence exposure times (0 to 200 ms), various laser powers, and with unique filter configurations. Tumor-to-noise ratio (TNR) for images was generated using region of interest software.Results: Pulmonary adenocarcinomas highly express FRα. Significant autofluorescence from native thoracic tissues was found with the highest fluorescent signals at the bronchial stump (547 ± 98, range 423-699), the pulmonary artery (267 ± 64, range 200-374), and cortical bone (266 ± 17, range 243-287). High levels of autofluorescence were appreciated after systemic administration of EC17; however, TNR was improved by altering exposure settings at the time of the imaging. Optimal fluorescent exposure time occurs at 40 ms (25 frames/s).Conclusions: Exposure properties can be manipulated to maximize TNR thus allowing for successful intraoperative detection of pulmonary adenocarcinomas during surgery. Optimization of the conditions for intraoperative molecular imaging sets the stage for future clinical trials utilizing targeted IMI techniques which can aid the surgeon at the time of cancer resection. [ABSTRACT FROM AUTHOR]

Background: In early-stage esophageal adenocarcinoma (EAC), esophagectomy improves staging but also increases mortality compared with endoscopic resection. Our objective was to quantify esophagectomy mortality and lymph node metastasis (LNM) risk in early-stage EAC to improve surgical treatment allocation. Methods: We identified National Cancer Database (2004-2014) patients with nonmetastatic, Tis, T1a, or T1b EAC who had primary surgical resection and microscopic examination of at least 15 lymph nodes. Univariate and multivariable logistic regression identified predictors of LNM. Cox regression identified predictors of death. The Kaplan-Meier method predicted overall survival (OS). Results: In 782 patients, LNM rates were: all patients 13.8%, Tis 0%, T1a 3.6%, T1b 23.4%. Independent predictors of LNM were submucosal invasion, lymphovascular invasion (LVI), decreasing differentiation, and tumor size ≥ 2 cm ( P < 0.05). For T1a tumors with poor differentiation or size ≥ 2 cm, LNM rates were 10.2 and 6.7%, respectively; 90-day mortality was 3.1%. The LNM rate in well differentiated T1b tumors < 2 cm was 4.2%; 90-day mortality was 6.0%. Estimated 5-year OS was 80.2% versus 64.4% (T1a vs. T1b). LNM increased risk of death for T1a (hazard ratio [HR] 8.52, 95% confidence interval [CI] 3.13-23.22, P < 0.001) and T1b tumors (HR 2.52, 95% CI 1.59-4.00, P < 0.001). Conclusions: In T1a EAC with poor differentiation or size ≥ 2 cm, esophagectomy should be considered, whereas in T1b EAC with low-risk features (well-differentiated T1b EAC < 2 cm without LVI), endoscopic resection may be sufficient. Treatment guidelines for early-stage EAC should include all high-risk tumor features for LNM and stage-specific esophagectomy mortality. [ABSTRACT FROM AUTHOR]

Background: Advantages of minimally invasive compared with open hepatobiliary surgery include quicker functional recovery, decreased postoperative length of stay, and decreased postoperative opioid use. As more complex operations are approached in minimally invasive fashion, it is imperative to maintain safety and excellent oncologic outcomes. Methods: In this video, we demonstrate the key principles in performing a safe robotic extended right hepatectomy for colorectal liver metastasis following sound oncologic principles. Results: Key preoperative considerations include (1) early referral to a hepatobiliary surgeon, (2) careful review of cross-sectional imaging to identify the relationship of tumors to major vasculature and any aberrant vascular anatomy, and (3) liver volumetry for every right hepatectomy to determine the need for future liver remnant volume augmentation. Key intraoperative techniques include (1) liberal use of ultrasound before and during transection to determine the relationship of major vasculature to tumor to preserve liver parenchyma without compromising tumor margins, (2) external retraction with vessel loops placed on either side of the transection line as stay sutures to facilitate parenchymal transection, and (3) a crush clamp technique to safely identify and control crossing vessels while dividing liver parenchyma. Conclusions: With proper preoperative planning and intraoperative use of these techniques, the benefits of a minimally invasive approach can be achieved while maintaining excellence in surgical quality and safety. [ABSTRACT FROM AUTHOR]