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Simple Summary: Gastric cancer is a significant global health concern, with over one million new cases and approximately 769,000 deaths in 2020. This study is the first to thoroughly investigate the causes of death in early-stage gastric cancer, specifically comparing cancers located at the cardia and non-cardia regions of the stomach. By analyzing data from 9721 patients, we aim to understand the different survival outcomes and causes of death between these two groups. Our findings highlight important survival patterns and emphasize the necessity of early diagnosis and tailored treatment plans. This research provides crucial insights that can help healthcare professionals improve the management and prognosis of gastric cancer patients. Background: Many researchers believe that cardia (CGC) and non-cardia (NCGC) are two different types of tumors, having different features like incidence rate, risk factors, geographical location, and socioeconomic status. This study aims to investigate the causes of death (COD) survival rates among early gastric cancer patients with a focus on differences between CGC and NCGC. Methods: This retrospective study employed SEER*stat software (version 8.3.92) to analyze the SEER 17 plus dataset (2000–2019). Standardized mortality ratios (SMR) were computed. Relative survival and conditional survival post-diagnosis were calculated using R software (version 4.1.0) among the different subgroups. Results: Within the follow-up period, 55.4% (5381) died, predominantly within the initial year post-diagnosis. Esophageal cancer was the leading non-gastric cancer cause in CGC, while miscellaneous tumors dominated in NCGC. The 1-year and 5-year relative survival for CGC patients were 76.4% and 48.9% respectively, while for NCGC were 80.4% and 63.9%. The 3-year conditional survival after 1 year and 5e years of survival for CGC were 68.7% and 88.8%, respectively, while for NCGC were 82.2% and 93.5%, respectively. This means that the longer a person has survived after diagnosis with cancer, the greater the likelihood that person will survive for another 3 years. Conclusions: This study sheds light on the substantial impact of non-cancer COD in GC patients, underscoring the necessity of considering comorbidities in their comprehensive management and follow-up. Impact: This study contributes valuable insights for clinical decision-making and informs future research directions regarding CGC and NCGC. [ABSTRACT FROM AUTHOR]

Background: This study examined associations between cannabis use among U.S. adults with chronic health conditions in a nationally representative sample. Methods: Four cross-sectional waves of data from the BRFSS were used, spanning 2017–2020. Multivariate logistic regression analyses assessed (a) whether number of self-reported chronic health conditions was associated with current cannabis use in the past 30-days, and (b) whether type of major chronic health conditions reported was associated with using cannabis for medical reasons in the past 30-days. Results: From 2017 to 2020, the prevalence of past month cannabis use increased among all age groups, with the largest percent change occurring in the middle-aged adult group (6.5% to 10.8%). Individuals with more chronic health conditions had higher odds of using cannabis in the past month. Individuals who had arthritis, cancer (other than skin cancer), HIV/AIDS, COPD, and/or depressive disorder had higher odds of using cannabis for medical reasons. Conclusions: As states across America weigh the implications of making medical and/or recreational cannabis use legal, future research should specifically explore persons with chronic diseases who are cannabis users, as these individuals may represent a high-risk population that is self-medicating to mask symptoms and may need more attention from medical and public health professionals. [ABSTRACT FROM AUTHOR]

Simple Summary: This epidemiological study of adenoid cystic carcinoma (ACC) using data from the SEER system aims to investigate independent predictors of late mortality, including factors such as age, stage, and tumor location, as well as racial differences, geographical distribution, and lack of social support (being unmarried). A total of 5150 patients were identified. Our study revealed that stage, tumor location in the thoracic region, and treatment modalities, in addition to geographical distribution (Western region) and lack of social support (being unmarried), were identified as independent predictors of late mortality. While the SEER data are not designed to explain why disease patterns occur, they provide valuable insights into health-related issues that cannot be overlooked. Further studies are needed to determine why the Western region of the USA is associated with poorer survival compared to the Northeast. Objective: Adenoid cystic carcinoma (ACC) is a rare malignant tumor that mainly arises in the head and neck area. We aimed to compare the long-term survival of patients with ACC based on their geographic regions within the United States using the Surveillance, Epidemiology, and End Results (SEER) registry data. Methods: We queried the SEER database to evaluate the geographic distribution of ACC patients based on inpatient admissions. The states included in the study were divided into four geographical regions (Midwest, Northeast, South, and West) based on the U.S. Census Bureau-designated regions and divisions. Demographic and clinical variables were compared between the groups. Kaplan–Meier curves and Cox regression were used to assess late mortality. Results: A total of 5150 patients were included (4.2% from the Midwest, 17.2% from the Northeast, 22.5% from the South, and 56.1% from the West regions). The median follow-up was 12.3 (95% CI: 11.6–13.1 years). Median overall survival was 11.0 (95% CI: 9.2-NR years), 14.3 (95% CI: 12.4–16.4 years), 11.3 (95% CI: 9.7–14.8 years), and 12.0 (95% CI: 11.3–13.0 years) for Midwest, Northeast, South, and West regions, respectively. In multivariable analysis, older age, male sex, thoracic cancer, the presence of regional and distal disease, receiving chemotherapy, not undergoing surgical resection, and being treated in the West vs. Northeast region were found to be independent predictors of poor survival. We identified a significant survival difference between the different regions, with the West exhibiting the worst survival compared to the Northeast region. Conclusions: In addition to the well-known predictors of late mortality in ACC (tumor location, stage, and treatment modalities), our study identified a lack of social support (being unmarried) and geographic location (West region) as independent predictors of late mortality in multivariable analysis. Further research is needed to explore the causal relationships. [ABSTRACT FROM AUTHOR]

This study examined opioid and analgesic misuse, and associated reasons for misuse, among participants without cancer in the United States. We extracted data from three distinct waves of the National Survey on Drug Use and Health (NSDUH, 2017–2019). Using weighted multivariable logistic regression models, we examined the associations between misuse and its reasons. Among individuals without cancer who misused pain relievers, the top three reasons for misuse were to relieve physical pain (62.6%), to get high (29.2%), or to relax (28.9%). For compound analgesics, the top three reasons for misuse were similar: relieving physical pain (67.9%), getting high (22.1%), and relaxation (25.6%). Compared to participants who misused opioids, respondents using compound analgesics and other pain relievers had lowers odds of using pain relievers for getting high (all p <.05). Understanding the underlying reasons for opioid and analgesic misuse can inform development of public health policy and help in determining best practices for prescription and monitoring programs. [ABSTRACT FROM AUTHOR]

Objective: Electronic cigarette use represents an important college health concern. This investigation assessed demographic and behavioral correlates associated with actual and perceived e-cigarette use among a national sample of American college students. Methods: Respondents (n = 19,861) comprised college students from over 40 distinct American higher education institutions. Multivariable logistic regression assessed whether (1) alcohol, tobacco or marijuana use were associated with e-cigarette use; (2) perceived peer use of alcohol, tobacco or marijuana were associated with perceived e-cigarette use. Results: Approximately 5% of survey respondents self-reported using e-cigarettes within the past month. More than 7 out of every 10 respondents, however, thought the 'typical student' was an e-cigarette user. As perceptions of typical student substance use increased, respondents were far more likely to contend the typical student used e-cigarettes. Discussion: In addition to adopting smoke-free campus policies, university officials should disseminate accurate information regarding e-cigarette behaviors of students. [ABSTRACT FROM AUTHOR]

Background: Despite a litany of education and prevention efforts seeking to curtail alcohol and other drug (AOD) use behaviors of United States (U.S.) college students, AOD use remains pervasive among the American college student population. Socio-cultural reinforcement of AOD behaviors, such as pregaming (PG), are often considered normative aspects of the collegiate experience, potentially introducing, and/or exacerbating, AOD use among U.S. college students. Objective: Due to the unique relationship PG has with the U.S. college experience and sports culture, this study explored the relationship between PG prior to a live sporting event and frequency of alcohol use, and the likelihood of persons who pregame also engaging in polysubstance use (>1 substance during drinking/use event). Methods: This study was conducted with college students (n = 816) attending a large public university in the Southeastern Conference (SEC) who violated campus alcohol use policies. Results: Beyond the influence of important demographic covariates, PG (p <.001) was significantly associated with a greater frequency of alcohol use. Moreover, students who participated in PG festivities were nearly 2.5 times more likely to participate in polysubstance use. Discussion: PG prior to live collegiate sporting events has clear public health and policy implications. Future efforts should institute and enforce risk-management policies on college campuses and employ event-specific alcohol and polysubstance use prevention and intervention strategies. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with cancer are considered a vulnerable population and might have an increased risk for severe outcomes of coronavirus disease 2019 (COVID-19). We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) 2020 database, the largest inpatient database in the United States, to assess COVID-19 outcomes in cancer patients. We have demonstrated that cancer patients hospitalized for COVID-19 have increased odds of all-cause in-hospital mortality and acute respiratory failure compared with non-cancer patients. Lung cancer patients have been demonstrated to have the worst mortality outcome. Background: Coronavirus disease 2019 (COVID-19) caused significant mortality and mortality worldwide. There is limited information describing the outcomes of COVID-19 in cancer patients. Methods: We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) 2020 database to collect information on cancer patients hospitalized for COVID-19 in the United States. Using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system, adult (≥18 years) patients with COVID-19 were identified. Adjusted analyses were performed to assess for mortality, morbidity, and resource utilization among cancer patients. Results: A total of 1,050,045 patients were included. Of them, 27,760 had underlying cancer. Cancer patients were older and had more comorbidities. The all-cause in-hospital mortality rate in cancer patients was 17.58% vs. 11% in non-cancer. After adjusted logistic regression, cancer patients had a 21% increase in the odds of all-cause in-hospital mortality compared with those without cancer (adjusted odds ratio (aOR) 1.21, 95%CI 1.12–1.31, p-value < 0.001). Additionally, an increased odds in acute respiratory failure rate was found (aOR 1.14, 95%CI 1.06–1.22, p-value < 0.001). However, no significant differences were found in the odds of septic shock, acute respiratory distress syndrome, and mechanical ventilation between the two groups. Additionally, no significant differences in the mean length of hospital stay and the total hospitalization charges between cancer and non-cancer patients. Conclusion: Cancer patients hospitalized for COVID-19 had increased odds of all-cause in hospital mortality and acute respiratory failure compared with non-cancer patients. [ABSTRACT FROM AUTHOR]

Introduction: Because of the improved colorectal cancer (CRC) survival in the U.S., patients may live long enough after CRC diagnosis to the point where non–cancer‐related comorbidities may considerably impact their overall survival. In this study, we perform a long‐term analysis of causes of death (CODs) following nonmetastatic CRC with respect to different demographic and tumor‐related criteria. Materials and Methods: We gained access to the Surveillance, Epidemiology, and End Results data to review patients diagnosed with nonmetastatic CRC during 2000–2015. We calculated standardized mortality ratios (SMRs) for each COD following CRC. SMRs represented the change of risk of a specific COD following CRC diagnoses when compared with the risk in the general U.S. population. Results: We reviewed 302,345 patients, of whom 112,008 died during the study period. More deaths (68.3%) occurred within 5 years following nonmetastatic CRC diagnosis, with 76,486 deaths. CRC was the most common COD (51.4%) within 5 years of diagnosis followed by heart disease (15.2%) and other cancers (8.4%). As time passed after diagnosis, the number of CRC deaths decreased, and other noncancer causes increased to the point that after 10 years only 10.4% of deaths were attributed to CRC, 15.3% were attributed to other cancers, and 34.2% were secondary to heart disease. Conclusion: Following nonmetastatic CRC diagnosis, most deaths remain secondary to CRC. Other causes, including other cancers and cardiovascular disease, represent a significant number of deaths, especially in the 5 years following initial CRC diagnosis. Our findings help guide counseling patients with CRC regarding future health risks. Implications for Practice: Most common causes of death following nonmetastatic colorectal cancer (CRC) are heart diseases, other cancers, chronic obstructive pulmonary disease, and cerebrovascular diseases. Physicians should counsel patients regarding survivorship with cancer screening and focus on prevention of noncancer deaths. These findings should be considered by physicians who give care for survivors of nonmetastatic CRC. This article presents a population analysis of causes of death among patients with nonmetastatic colorectal cancer, focusing on different demographic and tumor‐related criteria and comparing the risk of each cause of death with the general population in the U.S. [ABSTRACT FROM AUTHOR]

Representing 10%-25% of the primary cardiac neoplasms, primary malignant cardiac tumors (PMCT) have a poor prognosis, yet with rare incidence. Constituting more than 50% of the PMCT, cardiac sarcoma has increased not only in incidence over the past five decades but also in severity. Patients with PMCTs, especially sarcomas, have the worst prognosis when compared with other cardiac or extracardiac tumors. This retrospective study was performed using SEER*stat software, latest version 8.3.9.2(5) by accessing seer 18 registries plus data (excl AK) Nov 2020 Sub (2000-2018) for standard mortality ratio (SMR). A total of 235 patients were identified of whom 49.4% were females. Most of our patients were Stage 4 (n = 81) and distant in location (n = 92). The most common treatment method was tumor-directed surgery (n = 164), chemotherapy (n = 146), and radiotherapy (n = 55). Furthermore, other associated cancers with cardiac sarcoma were rare, with ten cases with lung and bronchus cancer (SMR: 37.95, 95% confidence interval [CI]: 18.2, 69.8), four with bone and joints (SMR: 1726.05, 95% CI: 470.2, 4419.3). During a 5-year follow-up, 235 patients died primarily due to cardiac sarcoma (n = 182, 77.4%), other cancers (n = 34, 14.4%), and other noncancerous causes (n = 19, 8%), while the noncancerous causes were attributed mainly to cardiovascular diseases (n = 4, 21%, SMR: 4.95, 95% CI: 1.35, 12.67), septicemia (n = 2, 10.5%, SMR: 41.23, 95% CI: 4.99, 148.95). [ABSTRACT FROM AUTHOR]

Immediately following the attacks of 9/11 in New York, mainstream media outlets echoed the notion of Muslims as strangers who are unable to assimilate into American culture. The purported difficulty in the assimilation of Muslims in America was linked with their religious affiliation, an indelible marker of their ideology, and one that supersedes any national identity. Given the paucity of research on the assimilation of Muslims in America, this paper sought to explore if-and-how this group is assimilating into American culture. Utilizing a mixed-method design, we conducted focus groups, followed by a multi-state survey. Using segmented assimilation theory, we found evidence that Muslims with higher educational attainment and household incomes are well-assimilated. We also found that respondents who identify themselves strongly as Muslim are less likely to assimilate, preferring instead to maintain close in-group ties. We discuss the implications of these findings in greater detail. [ABSTRACT FROM AUTHOR]

Introduction: The American College of Cardiology (ACC) in USA and the European Society of Cardiology (ESC) in Europe have issued around 25 practice cardiology guidelines since 2008. The attention and impact of these guidelines have not been investigated yet. Aim: In this study, we aim to compare the attention brought up by ACC and ESC guidelines. Methods: Guideline documents were defined as documents published by either the ACC or the ESC, where recommendations with a specific level of evidence are clearly indicated. These documents were posted on their respective websites. For each document, we extracted the attention on blogs, news, social media, and other platforms to calculate a total score known as the Altmetric Attention Score (AAS). Then we compared AAS, citations, and other indices between ACC and ESC guideline documents. Results: A total of 26 US and 24 European cardiology guidelines were released between 2008 and 2018. We found a significant difference in the median AAS between American and European guidelines (p = 0.048). The median AAS for European and for American guidelines were 159 (104.25–392.5) and 79 (24–169.75), respectively. The US Contribution to the AAS was significantly higher than the European in both the European guidelines (p < 0.001, median contribution values were 7.6% vs 3.4%, respectively), and the American guidelines (p = 0.011, median contribution values were 12% vs 7%, respectively). Conclusion: The attention brought up by the European guideline documents was higher than the American guidelines, although most of the attention in both guidelines was contributed to by USA. [ABSTRACT FROM AUTHOR]

Background: The focus on noncancer causes of death in patients with breast cancer (BC) remains superficial. The objective of the current study was to assess and quantify causes of death after BC diagnosis.Methods: In total, 754,270 women with BC in the United States who were diagnosed during 2000 through 2015 and retrieved from the Surveillance, Epidemiology, and End Results (SEER) program were studied. Standardized mortality ratios (SMRs) for causes of death were calculated.Results: Of the included patients, 183,002 (24.3%) died during the follow-up period. The greatest proportion of deaths (46.2%) occurred within 1 to 5 years after diagnosis. Most deaths occurred from BC itself or from other cancers, and the number of BC deaths decreased as more years passed after diagnosis. The most common noncancer causes of death within <10 years after diagnosis were heart diseases followed by cerebrovascular diseases. However, >10 years after diagnosis, the most common noncancer causes of death were heart diseases followed by Alzheimer disease. Patients had a statistically significant higher risk of death from chronic liver diseases within 5 to 10 years after diagnosis compared with the general population (SMR, 1.23; 95% CI, 1.09-1.38) and had statistically significant higher risks of death from Alzheimer disease (SMR, 1.21; 95% CI, 1.14-1.29) and from diseases of the heart (SMR, 1.06; 95% CI, 1.02-1.09) >10 years after diagnosis.Conclusions: Although BC remains the most common cause of death after BC diagnosis, other non-BC causes of death (mainly heart and cerebrovascular diseases) represent a significant number of deaths among patients with BC. These findings provide important insight into how BC survivors should be counselled regarding future health risks. [ABSTRACT FROM AUTHOR]

Background Pancreatic cancer is the fourth most common cause of cancer-related deaths in the United States, with an estimated 45,750 deaths in 2019. Mortality outcomes seem to differ based on the ethnicity of the patients, with most studies focusing on the mortality and survival of Caucasians and African Americans. Little attention has been given, however, to Asian-American patients diagnosed with pancreatic adenocarcinoma (PAC). In this study, we aimed to investigate mortality rates in Asian-American patients with PAC. Methods The SEER 13 registries (Surveillance, Epidemiology, and End-Results) of the National Cancer Institute were used to study PAC cases during 1992-2015. The incidence and incidencebased mortality rates per 100,000 person-years, and the annual percentage changes were calculated using SEER*stat software and Joinpoint regression software. Results A total of 5814 PAC cases in Asian-American patients were identified. Most patients were older than 60 years (77.6%) and had metastatic disease (55.8%). The overall incidence of PAC among Asian-Americans was 5.740 per 100,000 person-years (95% confidence interval [CI] 5.592- 5.891]. Incidence rates were highest among males and patients older than 60 years. PAC incidence rates among Asian-Americans increased by 1.503% (95%CI 1.051-1.956; P<0.001) per year over the study period. PAC incidence rates increased over the study period for all sex, age, and stage subgroups. PAC incidence-based mortality among Asian-Americans increased by 4.535% (95%CI 3.538-5.541; P<0.001) per year over the study period. Conclusion The incidence of PAC in Asian-Americans, as well as incidence-based mortality rates, are on the rise, irrespective of age, sex or stage subgroup. [ABSTRACT FROM AUTHOR]

Mediastinal Yolk sac tumors (YST) are rare and highly malignant extragonadal germ cell tumors with rapid growth and early metastases. We sought to conduct a meta-analysis of published case reports/case series to compare differences in survival, demographics, and treatment modalities between adult and pediatric patients with YST. Ovid Embase, Cochrane, and Ovid Medline databases were searched for primary mediastinal pure YST cases. The primary outcome was overall survival (OS). Log-rank and Cox regression were used. This study is registered on PROSPERO (CRD42022367586). Among 846 studies, 87 met our inclusion criteria including 130 patients (Adults: 90 and Pediatrics: 40). About 41.5% of the patients were from the United States. The median age was 23.0 (Q1-Q3: 17.0–30.0), 88.5% were males, and (32.3%) were Asian. Stage II represented almost 40%. AFP was elevated in 96.9%. Respiratory distress was the presenting symptom in 65.4%. Chemotherapy, radiotherapy, and surgery were utilized in 84.6, 23.1, and 64.7% respectively. Median OS was 24 months (Adults: 23 months, Pediatrics: 25 months, P = 0.89). 3- and 5-year OS were 34.4% and 22.9% in adults and 41.5% and 41.5% in pediatrics, respectively. On multivariate analysis, anterior location of tumors, receipt of chemotherapy, and undergoing surgery were associated with better OS. Primary mediastinal YSTs are rare, but lethal neoplasms. Our meta-analysis showed that mediastinal YSTs mimic other non-seminomatous mediastinal GCTs in terms of clinical characteristics and available treatment options. Early diagnosis, neoadjuvant chemotherapy, and surgical resection are the key points for effective management and improved outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Adrenocortical carcinoma (ACC) is a rare cancer that commonly spreads to the liver, lungs and lymph nodes. Bone metastases are infrequent. Objective: The aim of this report was to describe the clinical characteristics, survival perspective, prognostic factors and frequency of adverse skeletal-related events (SREs) in patients with ACC who developed bone metastasis. Methods: This is a retrospective, observational, multicenter, multinational study of patients diagnosed with bone metastases from ACC who were treated and followed up in three European countries (France, Italy and The Netherlands) and one center in the United States. Results: Data of 156 patients were captured. The median overall survival was 11 months. SREs occurred in 47% of patients: 17% bone fractures, 17% spinal cord compression, 1% hypercalcemia, 12% developed more than one SRE. In multivariate analysis, cortisol hypersecretion was the only prognostic factor significantly associated with a higher mortality risk (hazard ratio (HR) 2.24, 95% confidence interval (CI): 1.19-4.23, P = 0.013) and with the development of a SREs (of border line significance). The administration of antiresorptive therapies (bisphosphonates and denosumab) was associated with a lower risk of death, even if not significant, and their survival benefit appeared confined in patients attaining serum mitotane levels within the therapeutic range. Conclusion: Bone metastases in ACC patients are associated with poor prognosis and high risk of SREs. Cortisol hypersecretion was the only prognostic factor suggesting a potential benefit from antisecretory medications. The therapeutic role of bisphosphonates and denosumab to improve patient outcome deserves to be tested in a prospective clinical trial. [ABSTRACT FROM AUTHOR]

Background: Transitional cell carcinoma (TCC) accounts for around 95% of bladder cancers and is the 4th most common cancer among men and the tenth most common in women, in the US. There is a constant need to clarify current TCC incidence and mortality rates among different population groups for better clinical practice guidelines. We aimed to describe the TCC incidence and incidence-based mortality by demographic and tumor-related characteristics over the last 40 years in the US.Methods: We obtained data from the SEER 18 registries to study TCC cases that were diagnosed between the years 1973 and 2014. We calculated incidence rates and incidence-based mortality rates in different demographic and tumor-related characteristics and expressed rates by 100,000 person-years. We then calculated the annual changes in incidence and incidence-based mortality rates and displayed them as annual percent changes (APCs).Results: There were 182,114 patients with TCC between 1973 and 2014 in the United States. Overall incidence rates of TCC increased 0.16% (95% CI, 0.02-0.30, p = .02) per year over the study period. However, the incidence declined significantly since 2007; (95%CI,-1.89- -0.77, p < .001), except among the elderly and African Americans, which increased significantly over the study period. Overall TCC mortality rates did not change over the study period. However, since 2000 it started to decrease significantly.Conclusion: TCC incidence and incidence-based mortality rates had been showing significant increases over the previous decades. However, significant declines in both incidence and incidence-based mortality rates have been observed over the recent years, except in some patients with certain racial groups. Improved understanding of the etiological and ecological factors of TCC could lead to further declines in incidence and incidence-based mortality rates. [ABSTRACT FROM AUTHOR]

Background: Pancreatic cancer is the fourth-leading cause of cancer deaths in the United States. The silent nature of the disease and its poor prognosis, the need for further research, along with the need to assess the outcomes of current approaches necessitate an ongoing evaluation of the epidemiology and mortality-trends of this malignancy. Continuous monitoring of disease-patterns, on population-levels, may help scientists assess the quality of healthcare delivery, boost their understanding of diseases' characteristics and risk factors, and detect gaps whereby further research is needed. None of the previous reports shed light on pancreatic adenocarcinomas (PAC), the most common type of Pancreatic Cancer, as the primary outcome. In this study we aim to investigate PAC's incidence and mortality trends over the last four decades in the United States.Methods: We used SEER 9 database to study PAC cases during 1974-2014. Incidence and mortality rates were calculated by sex, age, race, state and stage of PAC. Annual percent change (APC) was calculated using joinpoint regression software.Results: We reviewed 67,878 PAC cases; most of these cases were in the head of pancreas. Overall PAC incidence rates increased 1.03% (95% CI, 0.86-1.21, p <.001) per year over the study period. Rates of adenocarcinoma of the head of pancreas increased 0.87% (95% CI, 0.68-1.07, p <.001), and rates of adenocarcinoma of the body and tail of pancreas increased 3.42% (95% CI, 3.06-3.79, p <.001) per year during 1973-2014. PAC incidence-based mortality increased 2.22% (95% CI, 1.93-2.51, p <.001) per year. However, during 2012-2014 there was a statistically significant decrease in PAC incidence-based mortality; APC, -24.70% (95% CI, -31.78 - -16.88, p <.001).Conclusion: PAC's incidence and mortality rates have been increasing for decades. However, the last few years have shown a promising decrease in mortality. We believe that further advances in healthcare delivery and research can lead to a further mortality decrease. Future studies can use this paper as a baseline to keep monitoring the outcomes of PAC's therapy. [ABSTRACT FROM AUTHOR]

The US tight oil revolution has not only turned conventional wisdom on its head domestically, but has also changed the global direction of trade in crude oil, petroleum products, natural gas liquids (NGLs), natural gas and liquefied natural gas (LNG). The impact is so great that this revolution has led to a sea change in all of these markets, leading to lower prices, and has changed energy geopolitics in the process. In oil, the main change relates not only to quantity, but also the quality of crude, with significant implications for Organization of Petroleum Exporting Countries (OPEC). In petroleum products, US exports have competed head on with the main refiners in Europe, the Middle East and Asia. The main change in NGLs has been the taking of market share from some OPEC producers in Central and Latin America and the collapse of the pricing system. In natural gas, the main impact was the curtailment of landlocked Canadian gas, while Mexico became awash with cheap US gas. In LNG, the main change was the breakup of the old pricing system that linked LNG prices to oil prices. The impact is far reaching and only now are we realizing the significance of the impact of the US tight oil and gas revolution on global energy markets. [ABSTRACT FROM AUTHOR]

• A total of 165,969 patients with renal cell carcinoma (RCC) were included from the Surveillance, Epidemiology, and End Results (SEER) database of which 60,290 (36.3%) died during the follow-up. • A large proportion of RCC patients died of non-cancerous causes especially early-stage patients and advanced-stage patients who survive >5 years. • Coordination of multidisciplinary care with relevant specialists depending on the stage of the disease is needed to reduce mortality. There has been little focus on the non-cancer causes of death in patients with renal cell carcinoma (RCC). Therefore, we aimed to assess the frequency and risk of different causes of death, stratified by tumor stage, and demographics, after a diagnosis of RCC in the United States. Data on eligible patients with RCC from January 1, 2000, to December 31, 2018, in the United States were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Standardized mortality ratios for causes of death were calculated using the SEER*Stat software 8.3.9.2 for the overall population and stratified subgroups. A total of 165,969 patients with RCC were included and 60,290 (36.3%) died during follow-up. The majority of deaths were due to kidney cancer (51.3%) but a significant proportion was non-cancer causes (37.6%). The proportion of deaths attributed to RCC decreased with increasing follow-up with non-cancer causes becoming dominant after the fifth year following RCC diagnosis. Overall, cardiovascular diseases and cerebrovascular diseases were the most common non–RCC-related causes of death. AJCC stage I and localized RCC had the most deaths attributed to non-cancerous causes (66.2% and 61.2%, respectively) while AJCC stage IV and distant RCC had the most deaths due to RCC (86.2% and 86.5%, respectively). A large proportion of RCC patients die of non-cancerous causes especially early-stage patients and advanced-stage patients who survive >5 years. Coordination of multidisciplinary care with relevant specialists depending on the stage of the disease is needed to better prevent death overtime from non-cancer causes. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to determine the effect of hypoalbuminaemia as a marker of malnutrition on the 30-day postoperative complication rate and mortality in patients receiving surgical treatment for hip fractures using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.Methods: We analyzed all patients admitted with hip fractures receiving surgical treatment from 2011 to 2013. Patients were dichotomized based on their albumin levels; hypoalbuminaemia (albumin <3.5g/dL), and nonhypoalbuminaemia (albumin >3.5g/dL). Patient demographics, postoperative complications, and length of stay were analysed. Logistic regression analysis was conducted to assess the ability of albumin level for predicting postoperative complications, length of stay, and mortality.Results: A total of 10,117 patients with hip fractures were identified with 5414 patients with normal albumin levels, and 4703 with low albumin. Multivariate analysis showed that when controlling for comorbidities; hypoalbuminaemia alone was a predictor of postoperative complications (death, unplanned intubation, being on a ventilator >48h, sepsis, and blood transfusion), and increased length of stay (6.90±7.23 versus 8.44±8.70, CI 0.64-1.20, P<0.001).Conclusion: Hypoalbuminaemia alone can predict postoperative outcomes in patients with hip fractures. Furthermore, patients with hypoalbuminaemia had a longer hospital length of stay. Further studies are needed to assess whether nutritional support can improve postoperative complications in patients with hypoalbuminaemia. [ABSTRACT FROM AUTHOR]

The crisis in the Middle East has raised awareness about the challenges encountered by migrant populations, in particular, health-care access and delivery. Similar challenges are encountered by migrant populations around the world, including those entering the United States as refugees and/or survivors of torture as well as Mexicans and other Latin Americans crossing the border. During the 2016 International American Thoracic Society Meeting held in San Francisco, California, a group of researchers and health-care providers discussed these challenges at a minisymposium devoted to the respiratory health of migrants. The discussion focused on the increased incidence of airway diseases among individuals migrating to more developed countries, the problems created by sleep disorders and their implications for cardiovascular and mental health, the challenges inherent in the control of infections in refugee populations, and the problems resulting from deportation. The group also discussed the potential impact of novel strategies made available by Internet-based technologies and how these strategies could be deployed to support worldwide efforts in assisting migrants and refugees, even in countries that find themselves in the direst circumstances. These presentations are summarized in this document, which is not meant to be exhaustive, but to improve awareness about the challenges confronted by migrants and their host nations regarding respiratory health-care access and delivery, and about the need for adequate investment of resources to better define these challenges through research and for the development of efficient strategies for intervention. [ABSTRACT FROM AUTHOR]

The conflict in Syria has created the largest humanitarian emergency of the twenty-first century. The 4-year Syrian conflict has destroyed hospitals and severely reduced the capacity of intensive care units (ICUs) and on-site intensivists. The crisis has triggered attempts from abroad to support the medical care of severely injured and acutely ill civilians inside Syria, including application of telemedicine. Within the United States, tele-ICU programs have been operating for more than a decade, albeit with high start-up costs and generally long development times. With the benefit of lessons drawn from those domestic models, the Syria Tele-ICU program was launched in December 2012 to manage the care of ICU patients in parts of Syria by using inexpensive, off-the-shelf video cameras, free social media applications, and a volunteer network of Arabic-speaking intensivists in North America and Europe. Within 1 year, 90 patients per month in three ICUs were receiving tele-ICU services. At the end of 2015, a network of approximately 20 participating intensivists was providing clinical decision support 24 hours per day to five civilian ICUs in Syria. The volunteer clinicians manage patients at a distance of more than 6,000 miles, separated by seven or eight time zones between North America and Syria. The program is implementing a cloud-based electronic medical record for physician documentation and a medication administration record for nurses. There are virtual chat rooms for patient rounds, radiology review, and trainee teaching. The early success of the program shows how a small number of committed physicians can use inexpensive equipment spawned by the Internet revolution to support from afar civilian health care delivery in a high-conflict country. [ABSTRACT FROM AUTHOR]

ABSTRACT Personal travel time in U.S. urban areas has been stable, clashing with the assertion that urban sprawl greatly lengthens travel. Average commute time rises by 7.7 percent with each cross-sectional doubling of Metropolitan Statistical Area (MSA) jobs. Using the RELU-TRAN structural computable general equilibrium model of the Chicago MSA, we simulate the equilibrium effects of a 24 percent population increase projected from 2000 to 2030 by the Chicago Metropolitan Agency for Planning. If no new road capacity is added, then congestion per mile increases. Although the urbanized land area increases by 19 percent, indicating sprawl, the vehicle miles traveled (VMT) per car-trip decreases by 1.31 percent and the VMT per car-trip to work decreases by 2.78 percent. Car travel time increases by only 6.25 percent and commuting time by only 4.54 percent, from 30.3 minutes in 2000 to 31.7 in 2030 or 3.4 seconds per year. We further explore the effects of new road capacity, gasoline prices, public transit speed, fuel economy gains, limits on suburban construction, and importantly, the cross-elasticity of public transit use with respect to car times. The availability of public transportation, economizing on nonwork travel, and land use adjustments that increase job-residence proximity keep times stable. [ABSTRACT FROM AUTHOR]

Background: Single-center studies suggest an increasing incidence of acute pancreatitis (AP) in children. Our specific aims were to (i) estimate the recent secular trends, (ii) assess the disease burden, and (iii) define the demographics and comorbid conditions of AP in hospitalized children within the United States. Methods: We used the Healthcare Cost and Utilization Project Kids’ Inpatient Database, Agency for Healthcare Research and Quality for the years 2000 to 2009. Extracted data were weighted to generate national-level estimates. We used the Cochrane-Armitage test to analyze trends; cohort-matching to evaluate the association of AP and in-hospital mortality, length of stay, and charges; and multivariable logistic regression to test the association of AP and demographics and comorbid conditions. Results: We identified 55,012 cases of AP in hospitalized children (1–20 years of age). The incidence of AP increased from 23.1 to 34.9 (cases per 10,000 hospitalizations per year; P<0.001) and for all-diagnoses 38.7 to 61.1 (P<0.001). There was an increasing trend in the incidence of both primary and all-diagnoses of AP (P<0.001). In-hospital mortality decreased (13.1 to 7.6 per 1,000 cases, P<0.001), median length of stay decreased (5 to 4 days, P<0.001), and median charges increased ($14,956 to $22,663, P<0.001). Children with AP compared to those without the disease had lower in-hospital mortality (adjusted odds ratio, aOR 0.86, 95% CI, 0.78–0.95), longer lengths of stay (aOR 2.42, 95% CI, 2.40–2.46), and higher charges (aOR 1.62, 95% CI, 1.59–1.65). AP was more likely to occur in children older than 5 years of age (aORs 2.81 to 5.25 for each 5-year age interval). Hepatobiliary disease was the comorbid condition with the greatest association with AP. Conclusions: These results demonstrate a rising incidence of AP in hospitalized children. Despite improvements in mortality and length of stay, hospitalized children with AP have significant morbidity. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To develop and validate time-efficient automated electronic search strategies for identifying preoperative risk factors for postoperative acute lung injury. PATIENTS AND METHODS: This secondary analysis of a prospective cohort study included 249 patients undergoing high-risk surgery between November 1, 2005, and August 31, 2006. Two independent data-extraction strategies were compared. The first strategy used a manual review of medical records and the second a Web- based query-building tool. Web-based searches were derived and refined In a derivation cohort of 83 patients and subsequently validated in an independent cohort of 166 patients. Agreement between the 2 search strategies was assessed with percent agreement and Cohen K statistics. RESULTS: Cohen K statistics ranged from 0.34 (95% confidence interval, 0.00-0.86) for amiodarone to 0.85 for cirrhosis (95% confidence interval, 0.57-1.00). Agreement between manual and automated electronic data extraction was almost complete for 3 variables (diabetes mellitus, cirrhosis, H2-receptor antagonists), substantial for 3 (chronIc obstructive pulmonary disease, proton pump inhibitors, statins), moderate for gastroesophageai refiux disease, and fair for 2 variables (restrictive lung disease and amiodarone). Automated electronic queries outperformed manual data collection in terms of sensitivities (median, 100% [range, 77%-100%] vs median, 87% [range, 0%-100%]). The specificities were uniformly high (≥96%) for both search strategies. CONCLUSION: Automated electronic query building is an iterative process that ultimately results in accurate, highly efficient data extraction. These strategies may be useful for both clinicians and researchers when determining the risk of time-sensitive conditions such as postoperative acute lung injury. [ABSTRACT FROM AUTHOR]

Abstract: The treatment of patients with relapsed and refractory Hodgkin lymphoma (HL), especially those who relapse after autologous stem cell transplantation, remains challenging. Patients with HL whose disease relapses after stem cell transplantation are rarely cured with current treatment modalities, and have a median survival of less than 3years. Since no new drugs have been approved by the FDA for HL in more than three decades, there is a clear unmet medical need for drug development for this patient population. New treatment strategies that are based on targeting oncogenic signaling pathways are currently explored. This review will focus on emerging new treatment modalities that are currently under investigation for patients with relapsed classical HL. [Copyright &y& Elsevier]

Many Asian developing countries face an increasing drain of their scientific community as a current challenge. This study identifies the trends in Sri Lanka and investigates the nature and dynamics of the pull and push factors at play here and in host countries. We used the expatriate scientists' database of the National Science Foundation of Sri Lanka and a follow-up survey. A highest proportion of the expatriate scientists are in the USA, followed by Australia. The majority of respondents held postgraduate degrees; around 50% had doctoral degrees. 'Further studies' was the major reason for emigration, followed by better career prospects. Engineering was the most common specialization, followed by chemistry, agricultural sciences and microbiology/biotechnology/molecular biology. If their demands are adequately met, the majority of the expatriates were willing to return to Sri Lanka. The article discusses the relevance of policies adopted in other countries, such as India and China, for Sri Lanka. [ABSTRACT FROM AUTHOR]

We examined representations of Latinidad and masculinidad in a set of crime and independent films. Findings show that crime films emphasized marginality and suggested Latinos' inadequate cultural stock. They focused on violence and created notions of Latino inferiority based on class-specific presumptions of power, masculinity and success. The narratives suggest that Latinos lack the assertiveness and brilliance of the tough white gangster of the 1930s and 1940s. The deviant Latino is rather emotional and succumbs to his own vulnerabilities. He possesses an unfit masculinity which is linked to the presumed backwardness of his own ethnic community. The independent films reproduced some elements of these stereotypes, but one, Girlfight, situated Latinos in the context of racism, assimilation and multiculturalism. They offered a different narrative and a new Latino subject, one that somewhat destabilizes the coherence of racist and patriarchal messages found in the crime movies examined in this paper. [ABSTRACT FROM AUTHOR]

The article discusses various developments that took place in the Middle East and North America during 2008. While Saudi Arabia, as reported, adopted a new law that permit foreign individuals and business organizations to invest in the Saudi stock exchange, United Arab Emirates (UAE) passed a law that dealt with the enforcement of mortgages. The U.S. and the Libyan government resolved all roadblocks related to compensation for families of the victims of the 1988 Pan Am 103 Lockerbie bombing.

Meetings of global companies are often non-productive or derailed because of the lack of understanding of cross-cultural communications and the impact of cultural faux pas. This session will begin with a scripted ten-minute international sales meeting with managers from the U.S., South America, India, and the Middle East. Since almost all the comments made violate cultural norms and expectations of the meeting participants, each panelist will give a 5 minute summary of culturally appropriate behavior for meetings in their culture. The session will then replay the meeting where each of the participants where each of the participants talk and act in a multiculturaly appropriate manner, allowing the meeting to be successful. The audience will then be invited to comment and react. They will be given both transcripts and guidelines for culturally appropriate meetings and a document analyzing the cultural faux pas they witnessed. Conference attendees from the U.S. (Dr Art Shriberg), Middle East (Dr Anas Malik), and India (Richa Kumari) will participate (South American panelist to be named). [ABSTRACT FROM AUTHOR]

Analyzes the developed equilibrium model of multimodal travel time in the New York Metropolitan Area. Computation of the change in the consumer's surplus and the change in the producer's surplus; Presentation of the sensitivity tests; Formulation of the economic structure of the model; Discussion on how the model was calibrated from the data.

In this article the author discusses aspects of the article "An Ethically Justified Framework for Clinical Investigation to Benefit Pregnant and Fetal Patients," by F. A. Chervenak and L. B. McCullough within the issue. The author addresses Chervenak and McCullough's argument that both pregnant women and their fetuses are patients, discusses the conditions for patient-hood, and why having a framework for establishing criteria for patient-hood is important.

Background Numerous cancers including renal cell carcinoma (RCC) have been shown to have a significant survival disparity among genders with better survival in females. In this study, we aim to utilize a large cohort of Japanese patients to evaluate gender disparities in RCC survival thoroughly. Methods Data of Japanese patients with RCC diagnosed between 1973 and 2015 in the US was obtained using the American SEER database. We studied the overall and cancer-specific survival of Japanese patients according to different demographic and tumor-related factors, using Kaplan-Meier test and Cox models. Results We reviewed 1,142 patients of Japanese origins who median overall survival that was 92 months (95% CI, 80.592-103.408), and a median RCC-specific survival that was 196 months (95% CI, 148.187-243.813). Females showed a significantly better overall survival (p-value < 0.001) and RCC-specific survival (p-value < 0.001) when compared to males. However, when we adjusted age, sex, stage, and grade of cancer, undergoing cancer-targeted surgery, and marital status, female sex was not associated with different overall and RCC-specific survival outcomes; (HR = 0.787, 95% CI [0.605-1.022], p-value= 0.073) and (HR = 0.776, 95% CI [0.554-1.085] p-value= 0.138), respectively. On the other hand, older age was associated with significantly worse overall and RCC-specific outcomes; (HR = 1.049, 95% CI [1.036-1.061], p-value < 0.001) and (HR = 1.026, 95%CI [1.011-1.041] p-value= 0.001), respectively for each year of age. Conclusion An apparent better survival was observed in Japanese female RCC patients; however, once adjusted for different baseline characteristics, gender no longer played a significant role in patient survival. Larger studies with more patients are needed to confirm these results in Japanese patients. [ABSTRACT FROM AUTHOR]

Objective: The Pediatric Sepsis Biomarker Risk Model (PERSEVERE), a pediatric sepsis risk model, uses biomarkers to estimate baseline mortality risk for pediatric septic shock. It is unknown how PERSEVERE performs within distinct septic shock phenotypes. We tested PERSEVERE in children with septic shock and thrombocytopenia-associated multiple organ failure (TAMOF), and in those without new onset thrombocytopenia but with multiple organ failure (MOF).Design: PERSEVERE-based mortality risk was generated for each study subject (n = 660). A priori, we determined that if PERSEVERE did not perform well in both the TAMOF and the MOF cohorts, we would revise PERSEVERE to incorporate admission platelet counts.Setting: Multiple PICUs in the United States.Interventions: Standard care.Measurements and Main Results: PERSEVERE performed well in the TAMOF cohort (areas under the receiver operating characteristic curves [AUC], 0.84 [95% CI, 0.77-0.90]), but less well in the MOF cohort (AUC, 0.71 [0.61-0.80]). PERSEVERE was revised using 424 subjects previously reported in the derivation phase. PERSEVERE-II had an AUC of 0.89 (0.85-0.93) and performed equally well across TAMOF and MOF cohorts. PERSEVERE-II performed well when tested in 236 newly enrolled subjects. Sample size calculations for a clinical trial testing the efficacy of plasma exchange for children with septic shock and TAMOF indicated PERSEVERE-II-based stratification could substantially reduce the number of patients necessary, when compared with no stratification.Conclusions: Testing PERSEVERE in the context of septic shock phenotypes prompted a revision incorporating platelet count. PERSEVERE-II performs well upon testing, independent of TAMOF or MOF status. PERSEVERE-II could potentially serve as a prognostic enrichment tool. [ABSTRACT FROM AUTHOR]

The article looks into the federal patent law of the U.S. which was first realized during the earlier period of the country's history. It reveals tat the well being of the industries in the area was the major concern for its introduction. In a survey conducted in 1998 by Quinn, the number of patent cases settled are indicated as well as the influence of alternative dispute resolution (ADR) on their resolution. However, it suggests that ADR process be improvised.