The proportion of lung cancers affecting individuals who have never smoked is growing, with these cancers being prone to harbor mutations in the EGFR gene. Little is known about risk factors and prognostic indicators for EGFR-mutant cancers, with current research limited by the scarcity of datasets integrating genomic, clinical, and environmental data. We created the Meyer Cancer Center Molecularly Enhanced Lung Cancer Database (MCC-MELD), including lung cancer cases from a large catchment area in New York City. We identified cases through linkage to our institution's cancer registry and a clinician-initiated, manually curated database. We linked all cases to the electronic health record and in-house tumor genomic testing results. We used natural language processing (NLP) to extract unstructured genomic testing results and detailed smoking history. We linked geocoded addresses to detailed area-level measures. MCC-MELD contains 9,573 patients with lung cancer diagnosed from 1988 to 2024, of whom 20% were non-Hispanic Asian, 14% were non-Hispanic Black, and 8% were Hispanic. We identified 1,092 (11.4%) EGFR-mutant cancers, with NLP identifying 397 cases not identified by structured data. NLP showed high accuracy in ascertaining EGFR status (97%) and quantitative smoking history variables (90%-98%). Never smokers made up 16% of the cases in MCC-MELD. MCC-MELD is an NLP-enhanced database containing clinical information, genomic testing results, and linkages to area-level data for patients with lung cancer from a diverse urban setting. This resource can facilitate studies on lung cancer risk factors, treatment patterns, and outcomes by EGFR and other driver mutation status.

Geographic access to lung cancer screening and environmental lung cancer risk factors in the contiguous United States.

Rainfall shapes CO₂ emission and dissolved organic matter dynamics in a karst catchment: Controlling factors revealed by isotopic and molecular signatures.

Lake Kivu is distinguished by several unique characteristics that set it apart from other lakes around the world. One of the notable features is a temperature increase with depth, accompanied by unusual staircase-like patterns in the thermodynamic and environmental parameters. The lake also experiences suppressed vertical mixing due to stable density stratification, with its deep water separated from the surface water by chemoclines. Additionally, Lake Kivu contains high concentrations of dissolved methane (CH4) and carbon dioxide (CO2), and there is no standard method for measuring their concentrations. The lake is also recognized as a renewable energy source due to its continuous supply of CH4, and it demonstrates a quadruple-diffusive convection transport mechanism. These factors contribute to the lake's distinctiveness. The occurrence of catastrophic limnic eruptions at Lakes Nyos and Monoun, along with the structural similarities between these lakes and Lake Kivu, raises serious concerns about the likelihood of a similar disaster in Lake Kivu in the future. The scale of threats posed in Lake Kivu can be orders of magnitude greater than the other two lakes, given its 3000 times larger size, two to four orders of magnitude higher content of dissolved CO2, containing substantial quantities of CH4 in addition to CO2 in solution, and holding a far denser population living in its much wider catchment area. The present study aims to assess the probability of a future gas outburst in this giant lake by numerical modeling of its hydrodynamics over the next half a millennium. The turbulent transport is calculated using the extended k-ε model. An implicit Euler method is applied to solve the governing partial differential equations on a vertically staggered grid system, discretized using a finite-volume approach. Since the previously calibrated model successfully reproduces the measured lake profiles, the same tuned parameter values are used in this study, assuming a stable steady-state condition in the future. The results of our simulations effectively address common concerns regarding the risk of a gas burst in the lake due to buoyancy instability-triggered overturn and/or supersaturation of the water column.

The First Step Is Knowing: Quantifying Social Need Through Screening in a Pediatric Surgery Clinic.

Spatial equity of physiotherapy accessibility in Aotearoa New Zealand in relation to Māori and Pacific ethnicity, socioeconomic deprivation, and rurality.

The upper course of the Neretva River, located in the rugged landscapes of Bosnia and Herzegovina (BiH), hosts a unique and largely unexplored ecosystem with significant biodiversity. This study aims to document the spider (Araneae) species inhabiting this region, including the Neretva’s wider catchment area, Nevesinjsko polje, and the Vranjača cave. Using various sampling methods, we identified 84 spider species from 72 genera and 22 families, with 50 (60%) species reported in BiH for the first time. Notable findings include the abundant Piratula knorri (Scopoli, 1763) (Lycosidae), and cave-dwelling species such as a region endemic Parastalita stygia (Joseph, 1882) (Dysderidae) and Lepthyphantes leprosus (Ohlert, 1865) (Linyphiidae). Our results emphasise the importance of this understudied region for spider biodiversity and underscore the need for ongoing research to enhance faunistic knowledge and inform conservation efforts in BiH.

The unique environmental settings and increasing human activity in Northeast China have intensified gully erosion, threatening food security and sustainable development. However, systematic studies of environmental thresholds driving gully erosion remain scarce. This study analyzed erosion gullies across four typical regions of Northeast China using Google Earth imagery (2011 to 2021) and field survey data (2021) to investigate the (1) conditions under which gullies most frequently form and develop and (2) conditions conducive to gully stabilization. Results showed that, in semi-humid areas, gullies mainly developed on cultivated land with a gradient of 6–15°, though catchment area thresholds varied. In contrast, in the semi-arid mountain and hilly area, developing gullies grew fastest in forested areas with low vegetation coverage. Overall, while there were differences across the four regions, gullies were most likely to form on cultivated land, while stabilized gullies were concentrated in forested areas. These findings indicate that the conversion of cultivated land to forested land slows the development of erosional gullies. In addition, rainfall promotes the formation of new gullies and inhibits the growth of eroded gullies by reducing the effective drainage area. The results provide a theoretical basis for the prevention and control of gully erosion.

Emergency department (ED) utilisation and delays are a major public health concern internationally, with increased mortality with ED delays and overcrowding. The study aimed to assess how the population characteristics of ED catchment areas are associated with ED use and delays to admission or discharge, and how catchment presentation rates are associated with ED delays. A cross-sectional study of presentations and delays to all 27 Scottish EDs for December 2023-February 2024. Catchment areas were defined for every ED in Scotland and population demographics for each, as Scottish Index of Multiple Deprivation (SIMD) and 8-fold Urban-Rural Classification (UR8). ED performance metrics for the study period were extracted from routinely reported data. Robust regression assessed the associations between catchment area demographics and ED delays, with negative binomial regression analysis of the association between catchment area demographics and presentation rates for the local population, reported as incidence rate ratio (IRR). For each decile lower (more deprived) in median SIMD, monthly attendances increased by 10% (IRR 1.10, 95% CI 1.10 to 1.11). For each step more rural in the median UR8 of a catchment, the percentage of patients experiencing a delay to admission or discharge of over 4 hours reduced by 5.3% (95% CI 4.9% to 5.7%), and each step more deprived in median SIMD decile of a catchment area was associated with 4.8% more delays beyond 4 hours (95% CI 3.0 to 6.8%). There was no association between presentation rates and delay to admission or discharge. EDs with more deprived catchment areas have higher presentation rates and greater delays in care. More rural EDs have fewer delays, which may mitigate some of the effects of geographical isolation in the provision of more timely care. In isolation, ED presentation rates are not associated with delays to care, adding to evidence that overall attendances are less important than other factors contributing to ED delays. Policymakers should consider the allocation of resources to best promote health equity.

This study aimed to determine the frequency and characteristics of patients discharged from a specialist community palliative care service, and the incidence, timing and reasons for discharge. This retrospective audit reviewed admissions and discharges over a 6-year period, including demographics, length of admission, discharge reason and readmission status. Of the 5149 admissions, 17% were discharged and 22% were later readmitted. 19% of readmissions were again discharged. The main reason for discharge was having no specialist palliative care needs (53%), followed by patients moving out of the service catchment area (13%). Median length of stay before discharge was 141 days, and median time from discharge to readmission was 214 days.A small group of 32 patients was referred, reviewed and immediately discharged, and most had a non-malignant diagnosis and were male. The main reasons for immediate discharge was the absence of palliative care needs or the service not being needed or wanted. A third of these patients were later readmitted. These data show that a substantial proportion of community specialist palliative care service patients are discharged. It raises further research questions around flexible models of care, validated discharge criteria and implementing quality measures on discharge.

Effect of Perinatally Acquired HIV Infection on Cognitive Function and Educational Attainment in Adolescents in the Era of Antiretroviral Therapy: A Cross-sectional Study in Zimbabwe.

The historical Ner River, receiving sewage for 150 years, has undergone significant hydrochemical changes. Natural hydrological conditions have also been substantially altered due to increased flood dynamics resulting from inflows from the sewered catchment area, which covers a significant portion of the Łódź agglomeration. Research conducted on the Ner River in the Konstantynów Łódzki area aimed to characterise the current hydrodynamic and hydrochemical conditions within the river valley, specifically focussing on its hyporheic zone (HZ). This study was conducted across three research profiles located approximately 5 km downstream from the discharge point of treated sewage from the Group Wastewater Treatment Plant in Łódź. Hydraulic conductivity measurements of riverbed formations indicate moderate to high permeability, facilitating substantial exchange between river water and groundwater due to the large morphological river bottom features. This was supported by vertical hydraulic gradient measurements, indicating predominant groundwater discharge within the profiles. Water samples collected from the riverbed exhibited diverse physicochemical features and chemical compositions. Metal content in the riverbed sediments of the Ner River decreased with increasing distance from the sewage discharge point. The HZ demonstrates the capability to mitigate natural disturbances, process nutrients and stabilise metals. Nevertheless, anthropogenic pressures disrupt the natural hydrological regime, chemical activities and biological processes. The study underscores the necessity of correlating chemical composition results with model estimates of upwelling or downwelling volumes for a comprehensive understanding of hydrochemical changes within heavily anthropogenically transformed river HZs. Furthermore, this correlation facilitates a reliable evaluation of hydrochemical variations within the HZ.

Background: Trauma care across Vancouver Island is delivered at two trauma centers which serves a population of 864,000. As part of program planning and delivery we routinely monitor Patient Safety Learning System (PSLS) reports, survey staff, and conduct case (MTPRC) reviews. Using these mechanisms, we identified the need to standardize care practices, improve staff training, and simplify the management of thoracostomy tubes. Our intervention introduced a digital chest drainage system to replace the gravity drainage system. Methods: We used a mixed-methods approach to identify practice issues and design and analyse quality improvement (QI) efforts. We analyzed open and directed staff surveys, text parsed bulk PSLS reports, and manual selected MTPRC cases. PSLS and MTPRC responses were coded thematically using conventional content analysis. Staff satisfaction with the QI work was assessed using Wilcoxon signed-ranks testing. Ongoing longitudinal assessment of the QI intervention will be used to describe the clinical impact of the QI intervention. Results Surveys identified that most nurses, 57.5% (n=40), wanted chest tube training. The least understood aspects of care were assessing air leaks, tidalling and excess negativity; and changing the collection canisters. We screened PSLS reports between 2022 and 2024 (n=4300), limited them by catchment area (n=1945), text-parsed them as chest-tube related (n=116), then manually screened them to identify 11 trauma-related chest tube events. Coding of PSLS (n=11) and MTPRC cases (n=14) identified two causal themes: i) management inconsistency (in physician ordering and clinical governance) and, ii) devices issues (chest tubes, securement, collection canisters and space). These cases resulted in delayed care (including prolonged stay) in three cases, unnecessary tube (re)placement (n=12), and clinical deterioration (n=3). Our QI initiative implemented a digital drainage system. Digital systems automatically modulate thoracic negativity, digitally display air-fluid leaks and tidalling, and provide audio-visual alarms and prompts to address pump and collection canister issues. Orientation sessions trained 76.5% of staff. Postimplementation surveys (n=18) showed 61.1% or respondents had used the digital system. Most rated the digital system as safer (z=3.67, r=0.61, p<0.01), easier (z=3.66, r=0.61, p<0.01), superior (z=3.78, r=0.63, p<0.01), and preferable (z=3.87, r=0.64, p<0.01) to gravity drainage. The response was not attributable to difference in the perceived level of training (z=1.41, p=0.16). Ongoing analysis on the clinical effect of the system will be available by the time of the conference. Implications and lessons learned We used small-scale surveys to assess staff, large-scale PSLS surveillance to identify rare safety events, and a mixed-methods approach to identify opportunities for QI. We used digital chest drainage system to address the most cited challenges in chest tube care. As a result, we have seen an increase in staff perceptions of patient safety and ease of care. Ongoing analyses will determine if this initiative is correlated with changes in patient outcomes and safety events.

Spatial modelling of polycyclic aromatic hydrocarbon distribution in a Canadian ice wedge polygon tundra landscape.

The urban area of Wanzhou District in Chongqing frequently experiences flooding and sewage overflow pollution due to its steep topography, frequent and intense short-duration rainstorms, and inadequate drainage capacity. To address these issues, this study integrated sponge city concepts with low-impact development (LID) measures to establish a stormwater management framework for the Guoben Road catchment area. Hydrometeorological and drainage data were obtained from local monitoring stations. Utilizing high-resolution remote sensing imagery and a 30 m-resolution digital elevation model, 50 sub-catchments were delineated in ArcGIS. Based on regional soil information and national sponge city design guidelines, a Stormwater Management Model employing the Horton infiltration method was constructed. This model simulated runoff and sewer network performance under Chicago design storm conditions with return periods of 1, 3, 5, and 10 years. Results indicate that LID facilities (permeable pavements and rain gardens) substantially reduced runoff generation and enhanced drainage system efficiency. Across the four rainfall scenarios, the total decrease in runoff volume ranged from 69.3% to 79.3%, with runoff coefficients falling from 0.51–0.61 to 0.10–0.19. The decrease in outfall discharge ranged from 11.0% to 76.1%, with peak flow reduced by up to 70.4%, most notably during the 1-year return-period event. Mitigation effects diminished during higher-return-period storms, attributed to limited LID storage capacity and rapid soil saturation, which reduced infiltration and detention capabilities during intense rainfall events. Overall, this integrated LID scheme effectively enhanced infiltration capacity within the mountainous urban catchment, reduced peak flows, and alleviated sewer network overloading. This study provides technical support for stormwater risk management, sewage overflow pollution control, and sponge city planning in Wanzhou District, Chongqing, and other cities with similar topographic and hydrological characteristics.

Building dams and irrigation schemes as resilience measures against growing food insecurity and water scarcity may increase malaria risk in endemic settings. This study aims to assess the clinical and asymptomatic carriage of Plasmodium falciparum throughout the year and explores their association with socio-economic and weather factors in Nanoro, Burkina Faso. A monthly household-based surveys were conducted from March 2022 to February 2023 in five villages located at variable distance (3-40km) from the Soum dam located in the Nanoro Health district catchment area. Socio-demographic, weather, and economic data were collected using a standardized questionnaire. Capillary blood samples were analyzed for P. falciparum infection by microscopy. A mixed-effects logistic regression model adjusted for socio-economic and environmental factors was used to assess the infection probability and to analyze how village-level and month-level factors contributed to the malaria infection risk. A total of 13,786 participants were included. The overall prevalence of asymptomatic carriage (24.5%) was higher than clinical cases (19.5%). The 12-month malaria prevalence (clinical cases and asymptomatic carriage) were 39.6% (95%CI 38.79-40.42) with the highest rate (42.1% with 95% CI 40.7-43.47) reported from Soum near the dam and lowest rate (33.2%;95% CI 31.21-35.32) from Séguédin located far from the dam. Regardless of village location and transmission period, participants aged 5-19years old had the highest prevalence of malaria infection with values ranged from 43.6% (95% CI 38.34-49.01) in Séguédin to 69.4% (95% CI 64.94-73.57) in Soum. Monthly rainfall measured in millimeters, was unexpectedly associated with decreased risk of malaria infection (OR = 0.77, 95%CI 0.66-0.9). The risk of malaria infection was higher in villages close to the dam, with Soum having the highest prevalence and Séguédin the lowest. This study highlights the impact of dam construction on the epidemiological profile of malaria and underscores the need for multi-sectoral approaches integrating health, water management, and socio-economic interventions to tackle the risk of the disease occurrence.

Soil loss due to erosion is a widespread problem in agricultural landscapes. However, a scarcity of long-term datasets and lack of reliable models challenge our understanding of the mechanisms that cause erosion. We developed a novel method for merging sediment core analysis with event-based sediment yield modeling using the Modified Universal Soil Loss Equation. The method was applied to a geographically isolated wetland in southwestern Georgia for a period from 1940 to 2022 using the Soil and Water Assessment Tool. This period included transitions from small-scale farm operations to plantation forestry to industrial, irrigated agriculture. Our results show a distinct spike in sedimentation rate in the 1970s with a peak of 872mg per cm2 of wetland area per year, or 3.6 metric tons of erosion per ha of catchment area. This spike occurred during a transitional period in land use that was also characterized by several large winter rain events. Both sediment core and modeled data indicate that these episodic sedimentation events dominate the long-term sediment record. Disagreement between the temporal pattern of sedimentation predicted by the model and those calculated from the sediment core was evident in certain parts of the sediment record. Our comparison suggested that sediment yield models require a unique calibration to accurately represent historical agricultural practices. The analysis also provides evidence that autochthonous sedimentation rates may be increasing in the most recent decade of the record due to anthropogenic changes.

Against the backdrop of rapid urbanization and an increase in extreme rainfall, the impermeable expansion caused by land use changes is significantly altering the urban property convergence process and intensifying the risk of waterlogging. To reveal the impact of land use change on the urban flooding processes, this study takes the main urban area of Wuhan (MUAW) as an example. Based on land use data from 2006 and 2020, it designs rainfall events with return periods of 5, 50, and 100 years. The NewFlood two-dimensional hydrodynamic model is employed to simulate flood evolution, with results validated against flood-prone locations. Flow velocity changes at typical flood-prone points are grouped and statistically analyzed according to land use conversion types. The results showed the following: (1) Between 2006 and 2020, land use transfer in MUAW is primarily influenced by urban sprawl and cropland reduction. (2) Urban expansion led to an increase in the area and depth of rainwater accumulation during rainstorms, which was highly aligned with the direction of urban sprawl, thereby increasing the risk of urban flooding during rainstorms. (3) Land use transfer has a limited impact on the maximum water depth and flow direction in MUAW. However, it can increase peak flow velocity or shift the peak time earlier, reducing the city’s available emergency response time and increasing the difficulty of emergency response. The contribution of this paper lies in quantifying the waterlogging effect of land use change from dynamic dimensions such as “flow velocity—peak occurrence time”, providing process evidence for the assessment of urban early warning advance, the allocation of drainage capacity and land use control, and offering a reference for prioritizing the layout of nature-based solutions and green infrastructure in low-lying catchment areas and key catchment channels to reduce flood risks.

Background: Burns result in approximately 180,000 deaths annually, with the majority occurring in rural regions of Africa and Southeast Asia. This study aimed to assess the available resources, key challenges, and potential solutions in burn care from the perspective of healthcare providers in India. Methods: An online survey was conducted among burn care professionals across India. The survey was disseminated via social media platforms, burn care networks, and hospital representatives. Results: A total of 105 respondents, primarily from tertiary care centers, participated in the survey. Of these, 64.2% were affiliated with government hospitals, and 40.1% served catchment areas extending beyond 300 km. Dedicated burn units were present in 88.0% of government hospitals, compared to 66.9% in non-government facilities. Treatment costs were significantly lower in government hospitals, with 88.8% offering care either free of charge or at minimal cost (p ≤ 0.00001). Conclusions: The findings reveal significant gaps in staff training, intensive care monitoring, and infection prevention. Many patients initially seek help from traditional healers, often delaying appropriate treatment and worsening outcomes. Enhancing education, implementing standard monitoring practices, and ensuring adherence to clinical protocols are critical steps toward improving burn care outcomes in India.

BackgroundA decreased level of consciousness (DLOC) at onset is infrequent in patients with acute ischemic stroke (AIS). We assessed stroke localization, patient and stroke characteristics, revascularization rates, and long-term outcome in consecutive AIS patients presenting with acute DLOC.MethodsWe assessed all AIS patients from 1/2003–6/2021 admitted to a single academic hospital. DLOC at stroke onset was defined as being described in the prehospital phase or being present on hospital arrival based. Using multivariable regression analyses, we compared patients with and without DLOC regarding anatomical stroke localization, baseline characteristics, frequency of revascularization, favourable functional 3-month outcome, and 12-month mortality.ResultsAmong 6491 consecutive AIS patients (median age = 74.8 years, IQR:20.2; 44.2% female), 778 (12%) had DLOC, representing 10.0% of patients from the primary catchment area. Strokes affecting the upper brainstem, thalamus or temporal lobes more frequently showed DLOC. DLOC was independently associated with multiple territory lesions, posterior circulation and right cerebral localization, unwitnessed stroke onset, stroke severity, initially missed stroke diagnosis (all adjusted p-values < 0.05). Admission temperature and systolic blood pressure showed a U-shaped association with DLOC. After multiple adjustments, favourable 3-month outcome was less frequent (adjusted OR (ORadj):0.54,95%CI:0.43–0.69) and 12-month mortality rate higher in DLOC patients (ORadj:1.35 (95%CI:1.16–1.56). The latter difference disappeared after adjusting for change of goals of care.ConclusionsThe 10% of AIS patients with DLOC most often involve the upper brainstem, thalami and temporal lobes. DLOC patients have a higher likelihood of unwitnessed stroke onset and of their stroke being missed. Long-term functional outcome is clearly worse and mortality higher with DLOC even after adjustment for other prognostic factors.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00415-025-13548-5.