2-year Period Research Articles

Effect of General Surgery Resident Participation in Thoracic Surgery on Oncologic Outcomes: An Observational Cohort Study.

Background: Despite increasing sub-specialization, general surgeons continue to perform oncologic thoracic surgeries. Our objective was to determine whether general surgery resident participation in thoracic surgery affects surgical quality or oncologic outcomes. We hypothesized that patient outcomes with and without resident participation would be similar. Methods: We retrospectively reviewed the electronic health records of patients with stage 0-IV lung cancer undergoing oncologic pulmonary resection at BLINDED FOR REVIEW during an 11-year period (2012-2022). Patients younger than 18years or older than 85years were excluded, as were those who had incomplete follow-up data or were unregistered in our institutional cancer registry. Patients were divided into groups based on whether residents or staff surgeons completed >50% of the critical portions of the operation. We compared 30-day morbidity outcomes, overall survival (OS), and disease-free survival (DFS). Results: Three hundred thirteen patients met inclusion criteria. Demographic and clinical characteristics were similar between groups, as were types of surgical resection and median operative times. A statistical difference was found in the distribution of surgical approach. The odds of morbidity were 65% higher in the Staff group (OR=1.65; 95% CI, 1.007-2.71). Resident participation was not significantly associated with OS or DFS (P =.32 and P =.54, respectively). Discussion: General surgery resident involvement in lung cancer operations is not associated with longer operative times but is associated with a higher likelihood of a thoracotomy. General surgery resident involvement was associated with decreased postoperative morbidity and did not significantly affect OS or DFS.

Saying more than her name: Characterizing fatal police violence against Black women & girls in the US, 2000–2019

BackgroundBlack women and girls (BWGs) face an elevated risk of being killed by police, yet few studies have focused on the proximal factors increasing their exposure to these deadly encounters. ObjectiveThis paper elucidates the determinants and features of fatal police encounters with BWGs over a 20-year period. We examined (1) the initial cause of police contact, (2) how the encounter unfolded and escalated to a fatality, and (3) trends in factors salient to how each case transpired. MethodsUsing the Fatal Encounters database, we identified 573 BWGs killed between 2000 and 2019. Using a qualitative descriptive approach, we leveraged case descriptions and triangulated with news articles, police reports, legal documents, and other texts about decedents to determine what happened in each case, why, and to what effect. ResultsWhile many fatal police encounters were precipitated by alleged criminal activity, a significant number were due to minor violations, public health crises, and domestic violence. Moreover, most BWGs were not the target of the police activity that ultimately killed them, and their deaths came as collateral damage from the aggressive policing of others. ConclusionAs the US continues to grapple with the role of policing in community safety, this work complicates the understanding of how police operate and impact communities, raising questions about how to effectively address root causes beyond carceral and punitive frameworks.

Cancer mortality among Colombian and foreign populations over a 15-year period

PurposeWe aimed to compare cancer mortality among foreign- and Colombian populations in Colombia during the period of 2006–2020. MethodsThis retrospective study utilized vital statistics from the Colombian National Department of Statistics (DANE). The dataset included variables such as age group, sex, country of permanent residency, insurance, education level, marital status, ethnicity, and cause of death. The population data to calculate rates was obtained from the Colombian census and the United Nations. Crude and adjusted rates as well as proportional mortality rates were calculated. ResultsA total of 561,932 cancer deaths occurred in Colombia from 2006 to 2020. The foreign population (country of permanent residency different to Colombia) had a lower crude cancer mortality rate (31.1 per 100,000 inhabitants) than the Colombian population (81.9 per 100,000 inhabitants). However, the age-adjusted cancer mortality rate among the foreign population was 253.6 per 100,000, compared to 86.1 per 100,000 among the Colombian population. The proportional cancer mortality was 10.4 % among foreign population compared to 17.4 % among Colombian population. ConclusionsThe proportional cancer mortality shows that the proportion of cancer-related deaths is greater among the Colombian population compared to the immigrant population. However, immigrants in Colombia have a higher age-adjusted cancer mortality rate than Colombians, indicating that immigrants have worse cancer outcomes than the Colombians even though the immigrant population is younger. This is likely due to the frequent barriers that immigrants encounter in accessing health care in Colombia. Future research needs to focus on access to care for the immigrant population by investigating cancer-related risk factors among immigrants and addressing their barriers to cancer prevention and treatment.

Multi-modality risk prediction of cardiovascular diseases for breast cancer cohort in the All of Us Research Program.

This study leverages the rich diversity of the All of Us Research Program (All of Us)'s dataset to devise a predictive model for cardiovascular disease (CVD) in breast cancer (BC) survivors. Central to this endeavor is the creation of a robust data integration pipeline that synthesizes electronic health records (EHRs), patient surveys, and genomic data, while upholding fairness across demographic variables. We have developed a universal data wrangling pipeline to process and merge heterogeneous data sources of the All of Us dataset, address missingness and variance in data, and align disparate data modalities into a coherent framework for analysis. Utilizing a composite feature set including EHR, lifestyle, and social determinants of health (SDoH) data, we then employed Adaptive Lasso and Random Forest regression models to predict 6 CVD outcomes. The models were evaluated using the c-index and time-dependent Area Under the Receiver Operating Characteristic Curve over a 10-year period. The Adaptive Lasso model showed consistent performance across most CVD outcomes, while the Random Forest model excelled particularly in predicting outcomes like transient ischemic attack when incorporating the full multi-model feature set. Feature importance analysis revealed age and previous coronary events as dominant predictors across CVD outcomes, with SDoH clustering labels highlighting the nuanced impact of social factors. The development of both Cox-based predictive model and Random Forest Regression model represents the extensive application of the All of Us, in integrating EHR and patient surveys to enhance precision medicine. And the inclusion of SDoH clustering labels revealed the significant impact of sociobehavioral factors on patient outcomes, emphasizing the importance of comprehensive health determinants in predictive models. Despite these advancements, limitations include the exclusion of genetic data, broad categorization of CVD conditions, and the need for fairness analyses to ensure equitable model performance across diverse populations. Future work should refine clinical and social variable measurements, incorporate advanced imputation techniques, and explore additional predictive algorithms to enhance model precision and fairness. This study demonstrates the liability of the All of Us's diverse dataset in developing a multi-modality predictive model for CVD in BC survivors risk stratification in oncological survivorship. The data integration pipeline and subsequent predictive models establish a methodological foundation for future research into personalized healthcare.

International collaboration leading to high citations: Global impact or home country effect?

Scientific research has become more collaborative, which brings a number of advantages including higher citation rates. This study examines the factors contributing to higher citations by distinguishing between the quality of work and the home country effect. Using international co-authorship as a key variable, we analyze citation patterns across a diverse range of fields over a 10-year period, and differentiate between citations accrued in the authors’ countries and citations received in other countries. The results demonstrate the presence of both global impact and a home country effect. Specifically, publications with international co-authorship receive significantly more citations from abroad, which strongly implies that international collaboration fosters high quality research and positively impacts citation rates, especially when considering the relatively smaller foreign community size once the authors’ home countries are excluded. On the other hand, it is also observed that domestic citations from authors’ countries increase faster than foreign citations and the effect is more pronounced over a longer period of time, which suggests that home country effect plays an important role in accumulating citations through the increased visibility in the domestic research community. The study confirms the pivotal role of international collaboration in research impact and highlights the significance of network building.

Potential assessment of CO2 source/sink and its matching research during CCS process of deep unworkable seam

It is of great significance for the engineering popularization of CO2-ECBM technology to evaluate the potential of CCUS source and sink and study the matching of pipeline network of deep unworkable seam. In this study, the deep unworkable seam was taken as the research object. Firstly, the evaluation method of CO2 storage potential in deep unworkable seam was discussed. Secondly, the CO2 storage potential was analyzed. Then, the matching research of CO2 source and sink was carried out, and the pipe network design was optimized. Finally, suggestions for the design of pipe network are put forward from the perspective of time and space scale. The results show that the average annual CO2 emissions of coal-fired power plants vary greatly, and the total emissions are 58.76 million tons. The CO2 storage potential in deep unworkable seam is huge with a total amount of 762 million tons, which can store CO2 for 12.97 years. During the 10-year period, the deep unworkable seam can store 587.6 million tons of CO2, and the cumulative length of pipeline is 251.61 km with requiring a cumulative capital of $ 4.26 × 1010. In the process of CO2 source-sink matching, the cumulative saving mileage of carbon sink is 98.75 km, and the cumulative saving cost is $ 25.669 billion with accounting for 39.25% and 60.26% of the total mileage and cost, respectively. Based on the three-step approach, the whole line of CO2 source and sink in Huainan coalfield can be completed by stages and regions, and all CO2 transportation and storage can be realized. CO2 pipelines include gas collection and distribution branch lines, intra-regional trunk lines, and interregional trunk lines. Based on the reasonable layout of CO2 pipelines, a variety of CCS applications can be simultaneously carried out, intra-regional and inter-regional CO2 transport network demonstrations can be built, and integrated business models of CO2 transport and storage can be simultaneously built on land and sea. The research results can provide reference for the evaluation of CO2 sequestration potential of China's coal bases, and lay a foundation for the deployment of CCUS clusters.

Generational Immigration Status Modifies the Association Between Psychosocial Distress and Substance Use Among Alternative High School Students

PurposeAlternative high schools (AHS) are designed to provide individualized education, more flexible scheduling, and smaller class sizes for students referred out of traditional high school. AHS students report higher levels of substance use (SU) and face disproportionately higher levels of trauma and toxic stress than their traditional high school peers. We sought to examine whether generational immigration (GenIm) status modifies the association of mental health and SU among AHS students using a longitudinal study of 1,060 Southern California AHS students. MethodsSubscales from the 21-item Depression Anxiety Stress Scale were administered. Effect modification was examined by GenIm status defined as first generation (born outside of the United States), second generation (born in the United States with a parent born outside the United States), or third generation (born in the United States with US-born parent(s)). Main outcomes included the number of times different substances were used in the past year over a 3-year period. ResultsMultilevel, negative binomial, covariate-adjusted latent growth curve models generated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of the time-varying association between depression, anxiety, or stress and the use of cigarettes, e-cigarettes, cigars, alcohol, or marijuana. Multiple-group models examined effect modification by GenIm status. DiscussionThe link between mental health and SU was stronger among first- and second-generation students than third-generation students. For example, a one-unit increase in stress relative to the average stress of students from the same school was associated with an increase in the rate of e-cigarette use among first-generation (IRR = 2.03, 95% CI = 1.07–3.85), second-generation (IRR = 2.25, 95% CI = 1.86–2.72), and third-generation (IRR = 1.68, 95% CI = 1.31–2.16) students. Effective strategies tailored to subgroups of AHS students are needed to counter disparities between traditional and alternative school systems that may contribute to long-term trajectories of SU.

Clinical impact of metagenomic next-generation sequencing of bronchoalveolar lavage fluids for the diagnosis of pulmonary infections in respiratory intensive care unit

BackgroundThe real-world clinical impact of mNGS on BALF in the respiratory intensive care unit (RICU) is not yet fully understood. MethodsWe investigated the clinical impact of mNGS on BALF samples obtained from 92 patients admitted to the RICU over a 2-year period. We utilized both mNGS and culture methods to evaluate the effectiveness of mNGS in diagnosing pulmonary infections. The clinical impact of mNGS were evaluated by the clinician committees. ResultsAmong the 92 diagnosed patients, 78 cases (84.7 %) were determined to have infectious diseases caused by pathogenic microorganisms, and the bacterial infections constituted the most prevalent diagnostic category. For mixed infection, the most common type was the Pneumocystis jironecii and cytomegalovirus co-infection. The mNGS results had a positive impact on the clinical management of 43 cases (46.7 %). Moreover, 19 cases (44.2 %) of positive clinical impacts were solely based on new diagnoses made possible by mNGS results. These new diagnoses were particularly helpful for identifying rare pathogens, which could not be detected by conventional diagnostic methods. ConclusionsThe BALF mNGS has a positive real-world impact in RICU. Clinician committee play a critical role in ensuring the appropriate use of mNGS.

Understanding pediatric snakebites: Clinical and epidemiological insights from a healthcare center in Bihar, India

ABSTRACT Background: Snakebites are a common medical emergency and occupational hazard for children in India, particularly in rural areas where poverty is prevalent. However, there is limited data on the epidemiology of snakebites on the Indian subcontinent. Objective: This cross-sectional, observational study aims to investigate the epidemiology, major clinical manifestations, and outcomes of snakebites in children under the age of 15 who were admitted to a tertiary care center in Bihar, a state in East India, and draw attention to this public health concern. Methods: A cross-sectional observational study was conducted at the Department of Paediatrics, Patna Medical College and Hospital, Patna. The study included all cases of snakebites with features of envenomation involving patients less than 15 years of age who were brought to the department over a 2-year period. Data were collected using a data collection form and analyzed using the Statistical Package for the Social Sciences, version 11.0 (SPSS Inc., Chicago, IL, USA). Results: A total of 59 cases were recorded, with 62.71% (n = 37) being male and 37.28% (n = 22) being female. Kraits were responsible for 38.9% (n = 23) of cases, vipers for 42.3% (n = 25), and cobras for 5% (n = 3). Fang marks were present in 67.7% (n = 40) of cases, and the majority of bites (84.7%, n = 50) occurred on a lower limb during the day. The age distribution showed that 16.9% (n = 10) were below 5 years old, 44% (n = 26) were between 5 and 10 years old, and 22% (n = 13) were above 10 years old. Traditional treatment was used in 44.7% (n = 22) of cases, with the most common treatments being local incision + tourniquet (22%, n = 13) and no traditional treatment (55.9%, n = 33). The highest number of cases occurred during July–September (35.5%, n = 21). Conclusion: Snakebites are a significant public health issue in Bihar, India, with the majority of cases occurring in rural areas. The study highlights the importance of increased awareness and preparedness among healthcare providers and the general public, particularly during the monsoon season. Early hospital transfer, prehospital management, and prevention should be promoted through regular public health initiatives.

Association of radiation-induced epilation and interventional neuroradiology procedures.

The aim of this study is to quantify the association of temporary epilation following interventional neuroradiology (INR) procedures and compare the peak skin dose (Dskin,max) threshold to published values. Gold Coast University Hospital (GCUH) is a major centre for INR with over 500 primarily interventional procedures performed every year. Dskin,max is calculated when the reference air kerma (Ka,r) exceeds 3 Gy. If the Dskin,max exceeds 3 Gy, the patient is followed up for any skin effects. An audit was undertaken of these results over a 2-year period. From January 2020 to December 2021, 140 patients who underwent INR procedures had a Ka,r > 3 Gy, 66 resulted in a calculated Dskin,max >3 Gy, and 45 were successfully followed up. Twenty patients (44%) reported no skin effects and 25 (56%) reported skin effects, which were almost exclusively epilation. The mean (range) Dskin,max for patients with no reported skin effects and those with observed skin effects was 4.6 Gy (3.0-11.1 Gy) and 4.2 Gy (3.0-7.0 Gy), respectively. These results demonstrate that temporary epilation was observed in 56% of patients, in a cohort of 45 patients who underwent an INR procedure with calculated Dskin,max >3 Gy and successful follow-up. The results support evidence in the literature that suggests the approximate threshold for temporary epilation reported by the International Commission on Radiological Protection (ICRP) may be too high for incidence of this effect, specifically on the scalp, when Dskin,max is calculated from Ka,r (using commonly used corrections and assumptions in the calculation).

Development and Assessment of a Sustainable PhD Internship Program Supporting Diverse Biomedical Career Outcomes.

A doctoral-level internship program was developed at the University of North Carolina at Chapel Hill with the intent to create customizable experiential learning opportunities for biomedical trainees to support career exploration, preparation, and transition into their post-graduate professional roles. We report the outcomes of this program over a five-year period. During that 5-year period, 123 internships took place at over 70 partner sites, representing at least 20 academic, for-profit, and non-profit career paths in the life sciences. A major goal of the program was to enhance trainees' skill development and expertise in careers of interest. The benefits of the internship program for interns, host/employer, and supervisor/principal investigator were assessed using a mixed-methods approach, including surveys with closed- and open-ended responses as well as focus group interviews. Balancing stakeholder interests is key to creating a sustainable program with widespread support; hence, the level of support from internship hosts and faculty members were key metrics analyzed throughout. We hypothesized that once a successful internship program was implemented, faculty culture might shift to be more accepting of internships; indeed, the data quantifying faculty attitudes support this. Furthermore, host motivation and performance expectations of interns were compared with results achieved, and this data revealed both expected and surprising benefits to hosts. Data suggests a myriad of benefits for each stakeholder group, and themes are cataloged and discussed. Program outcomes, evaluation data, policies, resources, and best practices developed through the implementation of this program are shared to provide resources that facilitate the creation of similar internship programs at other institutions. Program development was initially spurred by National Institutes of Health pilot funding, thereafter, successfully transitioning from a grant-supported model, to an institutionally supported funding model to achieve long-term programmatic sustainability.

Wound Healing Complications Associated with Staged Reconstruction after Facial Lentigo Maligna Resection.

Background: The rates and risk factors for wound complications following staged reconstruction after facial lentigo maligna (LM) resection have not been well described. Objectives: (1) To identify the rate and types of wound complications, including infection, graft necrosis, distal flap necrosis, hematoma, superficial epidermolysis, and seroma among patients undergoing staged reconstruction after resection of LM as documented in the surgeon's clinical notes within 30 days of the procedure. (2) To determine a threshold defect size that may predict the development of wound complications. Design and Outcomes: Retrospective review at an academic medical center of patients who underwent staged reconstruction after facial LM resection over a 5-year period. Results: Ninety-eight patients were identified with a mean age of 69.2 ± 13.6 years; 37% of patients were female. The most common defect sites were the cheek (n = 41; 42%) and nose (n = 22; 22%). Twenty-five of 98 patients (26%) demonstrated complications, with the most common being wound infection (36%) and graft necrosis (24%). Those receiving perioperative antibiotics had lower rates of complication (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.13,0.96; p = 0.041). Defects greater than 2.7 cm in maximal diameter had the highest sensitivity for predicting complications. Conclusions: Patients undergoing staged reconstruction after facial LM resection have a high rate of wound complication (26%) and defect size > 2.7 cm may be an important risk factor.

Deep phenotyping of unaffected carriers of pathogenic BMPR2 variants screened for pulmonary arterial hypertension.

Pathogenic variants in the gene encoding for BMPR2 are a major genetic risk factor for heritable pulmonary arterial hypertension (PAH). Due to incomplete penetrance, deep-phenotyping of unaffected carriers (UCs) of a pathogenic BMPR2 variant through multi-modality screening may aid in early diagnosis and identify susceptibility traits for future development of PAH. 28 UCs (44±16 years, 57% female) and 21 healthy controls (43±18 years, 48% female) underwent annual screening, including cardiac magnetic resonance imaging (cMRI), transthoracic echocardiography (TTE), cardiopulmonary exercise testing (CPET) and right heart catheterization (RHC). Right ventricular (RV) pressure-volume (PV) loops were constructed to assess load independent contractility and compared with a healthy control group. A transgenic Bmpr2Δ71Ex1/+ rat model was employed to validate findings in humans. UCs had lower indexed right ventricular end-diastolic (80±18 mL·m-2 versus 64±14 mL·m-2;p= 0.003), end-systolic (34±11 mL·m-2 versus 27±8 mL·m-2;p=0.024) and left end-diastolic volumes (69±14 mL·m-2 versus 60±11 mL·m-2;p=0.019) than control subjects. Bmpr2Δ71Ex1/+ rats were also observed to have smaller cardiac volumes than WT rats. PV loop analysis showed significantly higher afterload (Ea) (0.15±0.06 versus 0.27±0.08; p<0.001), and end-systolic elastance (Ees) 0.28±0.07 versus 0.35±0.10; p=0.047) in addition to lower RV-pulmonary artery coupling (Ees/Ea)(2.24±1.03 versus 1.36±0.37; p=0.006) in UCs. During the 4-year follow-up period, two UCs developed PAH with normal NT-proBNP and TTE indices at diagnosis. Unaffected BMPR2 mutation carriers have an altered cardiac phenotype mimicked in Bmpr2Δ71Ex1/+ transgenic rats. Future efforts in establishing an effective screening protocol for individuals at risk for developing PAH warrants longer follow-up periods.

Incidental discovery of unilateral hydronephrosis unveiling psoas major desmoid-type fibromatosis in a 24-year-old male: A case report with a 5-year follow-up.

Desmoid-type fibromatosis (DTF), also known as aggressive fibromatosis, is a rare neoplasm originating from the fascial or musculoaponeurotic tissues. While benign and characterized by slow growth, it exhibits local aggressiveness and lacks specific clinical characteristics. However, in a considerable percentage of patients, it could be asymptomatic and discovered by accident during routine clinical examinations. Only a few cases of DTF arising from the psoas major muscle have been reported in the medical literature. A 24-year-old male, asymptomatic and without significant personal or family medical history, was diagnosed with grade 2 hydronephrosis by abdominal ultrasonography during a routine physical examination. This diagnosis was made 15 days after undergoing uncomplicated open-heart surgery to repair an atrial septal defect. Intravenous pyelogram revealed hydronephrosis with dilation of the pelvicalyceal system. Ureteroscopy ruled out any intrinsic lesions of the ureter. Contrast-enhanced computed tomography identified a 3.5 × 2 × 5.2 cm mass in the retroperitoneum, closely associated with the psoas muscle and enveloping the ureter adjacent to the iliac artery. Postoperative pathological analysis confirmed a definitive diagnosis of sporadic DTF. The patient underwent exploratory abdominal surgery, during which the tumor was resected without any intraoperative complications. After close monitoring over a 5-year follow-up period, which included periodic physical examinations, magnetic resonance imaging, and ultrasonography, no local recurrence was detected. Achieving an accurate preoperative diagnosis presents a challenge in cases involving retroperitoneal tumors originating from the psoas major muscle and encasing the ureter. However, the insertion of a double J stent is deemed a crucial step in the surgical process, facilitating the dissection and isolation of the ureter from the tumor while preserving kidney function.

Cost-effectiveness analysis of a digital diabetes-prevention programme versus an in-person diabetes-prevention programme in people with prediabetes in the United States.

To assess the cost-effectiveness of a digital diabetes prevention programme (d-DPP) compared with a diabetes prevention programme (DPP) for preventing type 2 diabetes (T2D) in individuals with prediabetes in the United States. A Markov cohort model was constructed, simulating a 10-year period starting at the age of 45 years, with a societal and healthcare sector perspective. The effectiveness of the d-DPP intervention was evaluated using a meta-analysis, with that of the DPP as the comparator. The initial cycle represented the treatment period, and transition probabilities for the post-treatment period were derived from a long-term lifestyle intervention meta-analysis. The onset of T2D complications was estimated using microsimulation. Quality-adjusted life years (QALYs) were calculated based on health utility measured by short form (SF)-12 scores, and a willingness-to-pay threshold of $100 000 per QALY gained was applied. The d-DPP intervention resulted in cost savings of $3,672 from a societal perspective and $2,990 from a healthcare sector perspectiveand a gain of 0.08 QALYs compared with the DPP. The dropout rate was identified as a significant factor influencing the results. Probabilistic sensitivity analysis showed that the d-DPP intervention was preferred in 85.8% in the societal perspective and 85.2% in the healthcare sector perspective. The d-DPP is a cost-effective alternative to in-person lifestyle interventions for preventing the development of T2D among individuals with prediabetes in the United States.

Identification of Urban Expansion Driving Factors using CA-Markov model: a Case Study Demak and Jepara Regency, Indonesia

Land cover changes are a critical concern in a developing country where rapid urbanization and population growth intersect with environmental dynamics. Understanding the driving forces behind these changes is essential for sustainable development and effective land management. This study analyzes land cover changes in Demak-Jepara regency, Indonesia, over a 20-year period using Landsat data. The objective is to identify the dominant factors driving the increase in built-up areas, considering both natural and human-induced factors. Factors such as road distance, existing build area, and natural features are evaluated. Using ArcGIS and Idrisi Selva's Land Change Modeler, land cover data is processed, and Cellular Automata-Markov analysis is conducted. The study considers a cell size of 30 x 30 meters and a time step of 5 years from 2001 to 2009. Transition persistence analysis identifies significant factors, validated using 2020 land cover data through AUC (Area Under the Curve) and ROC (Relative Operating Characteristic) analysis. The combination of natural and human-induced factors (scenario-C) shows the highest AUC value of 0.9406, indicating better conformity with 2020 land cover. Dominant factors in scenario C include roads, existing built-up areas, river order, and slope gradient. Results reveal that road development and proximity to existing settlements are the primary drivers of land cover changes. Natural factors like river order and slope gradient have a lesser impact, while the coastline has minimal influence. These findings highlight the importance of considering both natural and human-induced factors in land use planning. They provide valuable insights for policymakers and land managers in making informed decisions for sustainable development and land use strategies. Keywords: Land Cover Changes; Driving Factors; Natural Factors; CA-Markov; Sustainable Development

Bilateral Mastectomy and Breast Cancer Mortality

The benefit of bilateral mastectomy for women with unilateral breast cancer in terms of deaths from breast cancer has not been shown. To estimate the 20-year cumulative risk of breast cancer mortality among women with stage 0 to stage III unilateral breast cancer according to the type of initial surgery performed. This cohort study used the Surveillance, Epidemiology, and End Results (SEER) Program registry database to identify women with unilateral breast cancer (invasive and ductal carcinoma in situ) who were diagnosed from 2000 to 2019. Three closely matched cohorts of equal size were generated using 1:1:1 matching according to surgical approach. The cohorts were followed up for 20 years for contralateral breast cancer and for breast cancer mortality. The analysis compared the 20-year cumulative risk of breast cancer mortality for women treated with lumpectomy vs unilateral mastectomy vs bilateral mastectomy. Data were analyzed from October 2023 to February 2024. Type of breast surgery performed (lumpectomy, unilateral mastectomy, or bilateral mastectomy). Contralateral breast cancer or breast cancer mortality during the 20-year follow-up period among the groups treated with lumpectomy vs unilateral mastectomy vs bilateral mastectomy. The study sample included 661 270 women with unilateral breast cancer (mean [SD] age, 58.7 [11.3] years). After matching, there were 36 028 women in each of the 3 treatment groups. During the 20-year follow-up, there were 766 contralateral breast cancers observed in the lumpectomy group, 728 contralateral breast cancers in the unilateral mastectomy group, and 97 contralateral cancers in the bilateral mastectomy group. The 20-year risk of contralateral breast cancer was 6.9% (95% CI, 6.1%-7.9%) in the lumpectomy-unilateral mastectomy group. The cumulative breast cancer mortality was 32.1% at 15 years after developing a contralateral cancer and was 14.5% for those who did not develop a contralateral cancer (hazard ratio, 4.00; 95% CI, 3.52-4.54, using contralateral breast cancer as a time-dependent covariate). Deaths from breast cancer totaled 3077 women (8.54%) in the lumpectomy group, 3269 women (9.07%) in the unilateral mastectomy group, and 3062 women (8.50%) in the bilateral mastectomy group. This cohort study indicates that the risk of dying of breast cancer increases substantially after experiencing a contralateral breast cancer. Women with breast cancer treated with bilateral mastectomy had a greatly diminished risk of contralateral breast cancer; however, they experienced similar mortality rates as patients treated with lumpectomy or unilateral mastectomy.

Are gaps in rates of retention on buprenorphine for treatment of opioid use disorder closing among veterans across different races and ethnicities? A retrospective cohort study

IntroductionThe U.S. Veterans Health Administration has undertaken several initiatives to improve veterans' access to and retention on buprenorphine because it prevents overdose and reduces drug-related morbidity. We aimed to determine whether improvements in retention duration over time was equitable across veterans of different races and ethnicities. MethodsThis retrospective cohort study was conducted among veterans who initiated buprenorphine from federal fiscal years (FY) 2006 to 2020 after diagnosis of opioid use disorder. Using an accelerated failure time model, we estimated the association between time to buprenorphine discontinuation and FY of initiation, race and ethnicity, and other control covariates. We followed veterans from buprenorphine initiation until they discontinued or had a censoring event. We then estimated the predicted median days retained on buprenorphine, the average marginal effect of initiating in a later FY, the same measure by race and ethnicity, the incremental effect of the various racial and ethnic identities in contrast to non-Hispanic White, and the total change in the size of the gap over the 15 years of the study between veterans with a minoritized racial or ethnic identity compared to non-Hispanic White veterans. ResultsMost of the 31,797 veterans in the sample were non-Hispanic White (74.5 %), from urban areas (83.5 %), male (92.0 %), and had significant comorbidities, most frequently anxiety disorders (51.0 %) and depression (63.0 %). Overall, 49.8 % of veterans were retained at least 180 days. The average marginal effect of FY was 7.0 days [95%CI:5.3, 8.8] but was significantly smaller among veterans identifying as Black or African American [3.2 days, 95%CI:2.4, 4.1] or Asian [3.6 days, 95%CI:1.6, 5.7] compared to veterans who identify as non-Hispanic White [7.9 days, 95%CI:5.9, 9.9]. Additional measures of change were significant for veterans identifying as Hispanic White or with two or more races. ConclusionAlthough buprenorphine retention in OUD treatment improved for all veterans over the 15-year study period, veterans from most minoritized racial and ethnic groups fell further behind as gains in duration on therapy accrued primarily to non-Hispanic White veterans. Targeted interventions addressing specific challenges experienced by veterans with minoritized identities are needed to close gaps in retention on buprenorphine.

Association between osteoporosis and the rate of telomere shortening.

A shorter leukocyte telomere length (LTL) is reported to be associated with age-related diseases, including osteoporosis. Many studies have tried identifying the association between LTL and osteoporosis, although it remains controversial. This study aimed to determine whether osteoporosis is independently associated with LTL shortening in a prospective longitudinal cohort. The KBASE study is an independent multicenter prospective cohort in South Korea, which began in 2014. We compared the LTL values for each participant at baseline and over a 2-year follow-up period. Boxplots were used to demonstrate the differences in the change in LTL over a 2-year follow-up according to osteoporosis. Multivariable linear regression was conducted to identify whether osteoporosis is independently associated with the rate of telomere shortening. A total of 233 subjects (from 55 to 88 years) from the KBASE cohort were finally enrolled in the study. We observed that the LTL decreased by approximately 1.2 kbp over 2 years. While the LTL decreased as age increased, the rate of LTL shortening did not increase with age. Multivariable linear regression analysis indicated that only osteoporosis was independently associated with rapid LTL shortening over 2 years (B, -8.08; p = 0.038). We sought to identify an association between osteoporosis and LTL shortening in an independent prospective cohort. We found that participants with osteoporosis had significantly faster LTL shortening over 2 years than those without osteoporosis. We hope this study will help elucidate the underlying mechanisms in the relationship between LTL and osteoporosis in the future.

Seasonal patterns of hip fracture incidence and mortality rates across age groups of older adults in Israel.

This study investigates the seasonal patterns of hip fracture occurrence and mortality rates in the elderly population of Israel. In this retrospective study, we examined a random sample of 400 patients who underwent a hip fracture repair surgery at a 495-bed hospital in northern-central Israel during the years 2021-2022. Our findings reveal a heightened incidence of hip fractures during the spring (30.8%) in contrast to relatively consistent rates during other seasons (22-24.2%). Patients experiencing hip fractures in the spring were notably younger and had shorter hospital stays compared to those in other seasons. Furthermore, we identified seasonal variations in hip fracture incidence concerning gender, culture, and nationality. Over the 2-year follow-up period, 20% of patients had succumbed to mortality. The highest survival rate was associated with hip fractures sustained in the spring, while the lowest rates were observed in the autumn and winter. While our study highlights significant seasonal variations in hip fracture occurrence and mortality rates among the elderly population in Israel, caution is warranted in interpreting the implications for post-fracture care and resource allocation. The observed heightened incidence of hip fractures during the spring, particularly among younger patients with shorter hospital stays, suggests the need for further investigation into potential risk factors and preventive measures specific to this season. Additionally, our identification of seasonal variations in hip fracture incidence across demographic factors underscores the importance of tailored interventions to address the diverse needs of different populations.