Distant Locations Research Articles

A detection of street trees and green space: Understanding contribution of urban trees to climate change mitigation

Urban trees are important for adapting to climate change; however, the absence of fine-grained data describing the distribution of urban tree crown cover and carbon stocks hinders recognition of the contribution of urban systems to climate change mitigation. Here, we present an approach for extracting fine-grained tree crown cover by coupling the Segment Anything Model and vegetation indices using Google Earth imagery with a spatial resolution of 0.298m. We estimated the aboveground biomass of tree-covered regions in Wuhan, representative of China's urbanization, using multi-source remote sensing data and machine-learning techniques. We show that tree crown cover accounts for 18.86% of the study area, implying that the nationwide proportion of urban trees probably represents 1.88–2.69% of the total forested area. Tree growth in urban regions remains reasonably stable owing to the high level of human management, with a 60–86 Mg C ha-1 carbon density of aboveground biomass in the tree-covered region in Wuhan. Street trees at specific distances from infrastructure represented an average level of aboveground biomass, whereas urban trees at relatively distant locations were the dominant contributors to aboveground biomass. Our study highlights the carbon stocks of urban trees and the various mechanisms that indirectly influence carbon emissions, representing a potentially promising nature-based solution. We recommend enhancing the socio-ecological characteristics of urban systems to address future climate change.

Mobile outreach clinics for improving health care services accessibility in vulnerable populations of the Diffa Region in Niger: a descriptive study.

Niger is a large country with many distant locations that can be difficult to access because the Sahara Desert covers 80% of the country's land. In Niger, just 49% of residents have access to a health centre within 5km of their house. Health care may be difficult to access in the Diffa region of Niger, as non-state armed groups strike on a regular basis and floods cause a high rate of vulnerability. This study looked at how mobile clinics can improve healthcare accessibility for vulnerable populations in the Diffa region. This was a descriptive-comparative study conducted over the period from 15 August 2022 to 15 October 2022, using three months' mobile outreach clinic to improve health outcomes in five districts of the Diffa region, including Bosso, Diffa, Goudoumaria, Mainé Soroa, and N'guigmi. During the three months of mobile outreach clinic, 42,251 people were sensitized about mobile outreaches and 12,004 were treated. A total of 18,708 vaccine doses were delivered to children aged 0-11months, with Maine Soroa, Goudoumaria, Bosso, Diffa, and N'guigmi districts accounting for 29.24%, 24.62%, 18.54%, 18.05%, and 9.5%, respectively. In the same line, Goudoumaria, Bosso, and Maine Soroa districts recorded relatively high antenatal clinic (ANC) attendance percentages of 27.85%, 25.62%, and 21.89%, respectively. Furthermore, mobile clinic outreach provided a variety of healthcare treatments, both curative and preventative. Mobile Clinic 2 increased vaccine dose received among children aged 0-11months by 1.11% (95%CI: 0.15%-2.06%, P = 0.023) when compared to Mobile Clinic 1. In the same line, mobile clinic showed a statistically significant increase of ANC between the three clinical rotations (P = 0001), showing an increased ANC update over time. This study found that mobile outreach clinic can play an important role in improving healthcare access for vulnerable populations in the Diffa region. However, well-designed, and frequent mobile clinic outreach should be planned and included in the country's public health policy.

TMIC-10. GENETIC LANDSCAPE OF BRAIN METASTASIS IN TRIPLE-NEGATIVE-BREAST CANCER: COMPARISON OF PAIRED PRIMARY AND METASTATIC TUMOR USING SPATIAL TRANSCRIPTOMIC ANALYSIS

Abstract The survival rate of individuals diagnosed with breast cancer has shown improvement over time, primarily attributed to advancements in early detection methods and the implementation of proactive treatment strategies. However, it is concerning that the incidence of breast cancer continues to rise, thereby leading to a corresponding increase in mortality rates among female breast cancer patients. Among these, the presence of brain metastasis is associated with a worse prognosis in individuals with breast cancer. Notably, triple-negative breast cancer exhibits a heightened propensity for the development of brain metastasis. Furthermore, there has been a notable rise in the duration of breast cancer survival, leading to a concomitant increase in the occurrence of metastatic cancer throughout the course of the disease. Presently, a greater number of patients are experiencing brain metastases, surpassing the figures reported in current statistical data. In instances of metastatic cancer, a distinct microenvironment that is particular to the tumor is formed in a distant location. The comprehension of the molecular genetic and immunological mechanisms involved in the several phases of brain metastasis, including tumor cell invasion, engraftment, and proliferation, has significant importance in the context of patient treatment and prognosis prediction. However, it is worth noting that a well-defined scientific foundation in this area is currently absent. The objective of this study was to analyze the molecular genetic characteristics of triple-negative breast cancer primary tumors and brain metastasis tumors. This was achieved by utilizing spatial transcriptome analysis technology to compare the differences in genetic profiles between the tumor cells and the surrounding tumor microenvironment. The findings of this study allowed for a comprehensive comparison of the tumor microenvironment at each site. In order to validate alterations in gene expression of various constituents and elucidate the mechanisms behind metastasis, it is imperative to conduct spatial confirmation.

Statistical Analysis of Atmospheric Delay Gradient and Rainfall Prediction in a Tropical Region

In recent years, precipitable water vapor has emerged as a key atmospheric parameter in weather prediction research. However, relying on only one parameter does not always accurately predict rainfall, as other atmospheric parameters also contribute to initiating rain events. In our previous study, we explored a methodology for rainfall forecasting based on the atmospheric delay gradient at an individual station in the tropical region. Commonly referred to as the atmospheric gradient, it accounts for the delay in GNSS signals due to changes in horizontal refractivity while propagating through the troposphere to the ground station. This paper discusses the spatial and temporal correlation of the gradient with precipitation occurring over a region. We have investigated different features, such as gradient magnitude, gradient convergence, and the flux of the atmospheric gradient, to propose potential nowcasting criteria for precipitation in the tropical climatic zone. The atmospheric gradient in the surrounding region orients toward the area of precipitation as the rain event approaches. This gradient gradually alters its orientation and converges toward the region of rainfall at the time of precipitation, introducing the concept of gradient convergence. This phenomenon results in an inward gradient flux at the time of the downpour, which presents a potential parameter for rainfall prediction over an area. We also proposed investigating area sizes of 4° × 4° or 8° × 8°, depending on the gradient feature, to establish a forecasting methodology for rainfall. The weather front in the tropical region begins to initiate 12 h before the actual time of occurrence and advances toward the area where it will have an impact from a more distant location. This article presents a detailed investigation of various features of the atmospheric gradient and its potential to nowcast rainfall for a region, as well as proposes the lead time for long-term weather predictions. Furthermore, a deep neural network has been employed to predict rainfall events for the next 6 h over an area in the tropical region.

Auditory competition and stimulus selection across spatial locations from midbrain to forebrain in barn owls

Barn owls enable investigation of neural mechanisms underlying stimulus selection of concurrent stimuli. The audio-visual space map in the optic tectum (OT), avian homologue of the superior colliculus, encodes relative strength of concurrent auditory stimuli through spike response rate and interneuronal spike train synchrony (STS). Open questions remain regarding stimulus selection in downstream forebrain regions lacking topographic coding of auditory space, including the functional consequences of interneuronal STS on interregional signaling. To this end, we presented concurrent stimuli at different locations and manipulated relative strength while simultaneously recording neural responses from OT and its downstream thalamic target, nucleus rotundus (nRt), in awake barn owls of both sexes. Results demonstrated that broadly spatially tuned nRt units exhibit different spike response patterns to competition depending on spatial tuning preferences. Modeling suggests nRt units integrate convergent inputs from distant locations across midbrain map regions. Additionally, STS within nRt reflects the temporal properties of the strongest stimulus. Furthermore, interregional STS between OT and nRt was strongest when spatial tuning overlap between units across regions was large and when the strongest stimulus location during competition was favorable for units in both regions. Additionally, though gamma oscillations synthesized within OT are weakly propagated within nRt, average gamma power across regions correlates with strength of interregional STS. Overall, we demonstrate that nRt integrates inputs across distant areas of OT, retains spatial information through differences in strength of inputs from various locations of the midbrain map across neurons, and prioritizes coding of identity features to the strongest sound.Significance StatementThe brain strategically selects and preferentially processes salient stimuli. A critical function to this process involves transferring salient information across regions that may exhibit drastic transformations in coding schemes. Our study in barn owls investigates bottom-up signaling between the midbrain space map and its downstream thalamic target, which lacks spatial topography as also observed in mammalian auditory forebrain regions to elucidate general mechanisms underlying how spatial location information and other properties of the strongest sound are relayed between regions. Results show that the thalamus integrates neural responses widely across the midbrain map, retains coding of spatial location through varying strength of inputs of the map across neurons, and prioritizes further coding of identity features only to the strongest sound.

Phylogenetic tree instability after taxon addition: empirical frequency, predictability, and consequences for online inference.

Online phylogenetic inference methods add sequentially arriving sequences to an inferred phylogeny without the need to recompute the entire tree from scratch. Some online method implementations exist already, but there remains concern that additional sequences may change the topological relationship among the original set of taxa. We call such a change in tree topology a lack of stability for the inferred tree. In this paper, we analyze the stability of single taxon addition in a Maximum Likelihood framework across 1, 000 empirical datasets. We find that instability occurs in almost 90% of our examples, although observed topological differences do not always reach significance under the AU-test. Changes in tree topology after addition of a taxon rarely occur close to its attachment location, and are more frequently observed in more distant tree locations carrying low bootstrap support. To investigate whether instability is predictable, we hypothesize sources of instability and design summary statistics addressing these hypotheses. Using these summary statistics as input features for machine learning under random forests, we are able to predict instability and can identify the most influential features. In summary, it does not appear that a strict insertion-only online inference method will deliver globally optimal trees, although relaxing insertion strictness by allowing for a small number of final tree rearrangements or accepting slightly suboptimal solutions appears feasible.

Online complementary interventions for the development of social communication in children during the early stage of the COVID-19 pandemic

For elementary school children, engaging in diverse communication experiences with peers of varying ages during free play is crucial for developing social adaptability. However, the COVID-19 pandemic caused an unprecedented interruption to this learning process, as the new school year in Japan, which typically starts in April, began with widespread school closures. A novel intervention was implemented to address the ongoing societal constraints of the “stay-at-home” mandate and the uncertainty surrounding its duration. This intervention aimed to facilitate and promote peer communication while minimizing the risk of COVID-19 infection. It utilized then-unfamiliar Internet-based conferencing systems on Children’s Day, 1 month into the new school year. We explored two main analytical aspects to enhance the efficacy of this communication method: first, the types of play proposed by children that attracted the highest participation from unfamiliar peers; second, the duration of participation and communication, particularly regarding age and gender differences. Remarkably, despite only 2 days’ notice, 15 children aged 4 – 14 from five different, previously unknown communities located 1,000 km apart participated enthusiastically. In the first investigation, 12 types of play were introduced by the children. The most engaging activities included collaborative drawing on a shared online whiteboard and a scavenger hunt for specified objects. Notably, older children participated significantly longer in the online presenter’s activities, while younger children preferred to play within their own community. This study proposes that online conferencing can facilitate social interaction among children during pandemics. The intervention successfully fostered collaborative play among children of varying ages and from distant locations. In addition, the findings indicate the necessity to adjust the quality and focus of interventions based on age-specific psychological development. Further verification with more implementation examples and a larger participant pool is required.

Home-Based Digital Exercise Training Program to Improve Physical Function of Older Sepsis Survivors: Protocol of the HEAL Sepsis Randomized Clinical Trial.

While sepsis, an exaggerated response to infection, can affect people of all age groups, it is more prevalent in middle-aged and older adults. Older adults suffer worse short-term and long-term outcomes than younger patients. Older sepsis survivors are commonly discharged to long-term acute care facilities, where they often die within 1 year. Those who return home from the hospital lose the momentum of physical function improvement after early inpatient rehabilitation, and often face exacerbation of comorbidities and decline in physical function. Additionally, patients who are discharged home often live at distant locations and are not able to commute to rehabilitation centers due to their poor health status. Therefore, remotely delivered exercise interventions tailored to this population hold promise to improve physical function safely and effectively after sepsis. However, this type of intervention has yet to be tested in this population. This study aims to assess the safety, feasibility, and ease of recruitment and retention of participants for a remotely delivered physical activity intervention for improving physical function in middle-aged and older sepsis survivors. The proposed intervention will be delivered through a digital health platform that comprises a patient-facing mobile app and a 12-week physical activity program specifically designed for middle-aged and older sepsis survivors with poor health status who may face challenges participating in traditional out-patient or community-based exercise interventions. This study is ongoing and plans to enroll 40 sepsis survivors aged 55 years and older who will be randomized to either a remotely delivered exercise intervention group or a control group (electronic health diary). Both groups will use a tablet containing the Health in Motion app (Blue Marble Health). The intervention group will receive a clinician-designed personalized avatar-guided home exercise program and reminders while the control group will self-report daily activities using the in-app health diary feature. This study is the first to use a home-based, remotely monitored 12-week exercise program to improve physical function in sepsis survivors. This study will evaluate the safety, feasibility, and efficacy, providing the necessary knowledge to design and calculate power for future larger trials. This study will provide important information for planning a future randomized clinical trial to test the efficacy of a remotely delivered exercise intervention in this high-risk population. ClinicalTrials.gov NCT05568511; https://clinicaltrials.gov/study/NCT05568511. DERR1-10.2196/60270.

Multi-functional periodically heterogeneous structures for energy harvesting and vibration attenuation-effects of piezoelectricity and shunting circuits

Abstract We explore a kind of metamaterial plate structures intended for simultaneous energy harvesting and vibration control. These structures are designed using a periodically perforated piezoelectric plate (the matrix) with elastic inclusions situated in the holes and serving for the resonators. The design options comprise two- and three-phase configurations related to the mechanical connection between the matrix and inclusions. By introducing a singularity—the focal spot created as a defect in the perfectly periodic structure and using the theory of super-cell, an enhanced piezoelectric energy harvester is obtained. It is observed that such a meta-structure serves as a dual-purpose system: efficiently capturing vibrational energy at a focal spot while maintaining the overall vibration attenuation throughout the structure. The band gap analysis based on the Bloch’s wave decomposition theory shows that by concentrating energy and halting vibration propagation, approximately 10 times energy harvesting enhancement and a remarkable 100 dB reduction in vibrations are achieved simultaneously. Besides the passive response of these meta-structures, we consider its extension by an external electric circuit (EC). Such modified configurations enable to exploit ‘actively’ the piezoelectric plate property to transmit the mechanical response between two, or more distant locations. Due to nonlocal interactions introduced by means the controllable EC, we consider optimization of the EC impedance to reduce the vibrations at a selected location of the whole structure without any external energy supply. The computational study discovers perspectives and benefits of designing such active self-powered meta-structures.

Expression of CD68 and CD163 in malignant epithelial cells of oral squamous cell carcinoma: Phenotypic shift or mere cell fusion

Background / purposeThe progression of epithelial to mesenchymal tissue (EMT) is a highly intricate process that facilitates the transformation of cancer cells, allowing them to changeover their characteristic epithelial properties to mesenchymal attributes. This notable change empowers the cells with enhanced mobility and the ability to migrate to distant locations. Furthermore, it is imperative to adopt the idea of macrophage tumor cell fusion to achieve comprehensive considerate of this phenomenon. Our primary objective was to conduct a thorough investigation of macrophage-restricted antigens expression, specifically CD68 and CD163, in malignant epithelial cells of oral cavity squamous cell carcinoma (OSCC) to elucidate aforementioned perceptions. Materials and methodsCD68 and CD163 immunohistochemical expression were assessed in oral squamous cell carcinoma (OSCC), encompassing both the neoplastic cells and the tumor-associated macrophages (TAMs). ResultsBoth CD68 and CD163 antigens were revealed in OSCC malignant epithelial cells in a granular cell pattern, localized in membrane and cytoplasm of tumor cells respectively as well as in the infiltrating TAMs. ConclusionThe macrophage antigens were not limited to the infiltrating tumor-associated macrophages (TAMs), but were also observed in a substantial proportion of OSCC malignant epithelial cells within the tumor parenchyma. This particular expression pattern may represent a subset of tumor cells that have undergone an epithelial to a mesenchymal phenotypic transition. In addition, fusion of macrophages with tumor cells cannot be excluded; both might be associated with increased metastatic activity of OSCC.

5099 Capturing the Patient Voice for Diabetes Eye Exams

Abstract Disclosure: S. Du: None. S. Lambrechts: None. M. Freeby: None. M. Han: None. Background: Diabetic retinopathy (DR) is a leading cause of blindness among adults 20-74 years old. Ophthalmic exams are recommended every 1-2 years for type 2 diabetes patients with minimal to no DR. The 50th percentile Integrated Healthcare Association benchmark for DR screening is 49%, but at our academic medical center, the completion rate is 30%. Potential barriers to screening noted in the literature include lower levels of education, lack of knowledge about DR, and financial barriers. Objective: To understand motivating factors and barriers to DR screening among patients in our health system. Methods: We utilized the Patient Voice qualitative research method to uncover themes and identify interventions to improve care delivery. The literature was synthesized to develop a structured interview guide. From our urban academic health system, 15 patients were randomly selected for interview, six of whom had completed the “Diabetes Eye Exam” care gap and nine that had not. Interviews were transcribed and coded for thematic analysis. Results: Six opportunity areas were identified. 1) There are currently only six retinal cameras located across primary and specialty care clinics serving more than 38,000 diabetes patients. 67% of patients felt the current clinic locations were inconvenient, with distant locations and long travel times. 2) 20% of patients expressed that they would like increased flexibility of appointments offered, such as evening, weekend, and same day appointments. 3) Patients were motivated by automated diabetes eye exam specific reminder messages and appreciated the ability to self-schedule within the patient portal. 47% of patients wanted yearly reminder messages, while 40% had no preference. 4) 53% of patients expressed that they did not fully understand DR or were confused about the difference between an optometrist exam and diabetes eye exam. 5) 40% of patients completed their eye exam with their local optometrist and found this to be a more convenient option. One patient expressed that she wished her doctor had informed her that she could complete her diabetes eye exam at a local optometry clinic. 6) If patients do choose to complete their exam with their local optometrist, they would like reminders to send their records to their primary care physician or endocrinologist. A more streamlined processes to upload outside records through the patient portal would decrease this barrier. Conclusion: It is important to engage patient stakeholders and understand their needs to improve overall experience and close care gaps. Through the Patient Voice, we learned that factors such as driving distance, traffic, scheduling, and issues with uploading records are major barriers to care gap completion. Convenient clinic locations, education, and reminder messages are motivating factors. Future work will focus on developing and implementing solutions in each opportunity area. Presentation: 6/1/2024

9375 Acth-Producing Pituitary Carcinoma in the Falx Cerebri and Other Unusual Locations

Abstract Disclosure: J.E. Esquivel Vargas: None. A. Cob Guillén: None. A.B. Santos Rojo: None. A. Hong Lo: None. ACTH-producing Pituitary Carcinoma in the Falx Cerebri and other unusual locations Background: Pituitary carcinoma is a condition defined by metastasis of a pituitary tumor to a distant location. Pituitary carcinomas are very rare and account for approximately 0.12% of adenohypophyseal tumors (1). Clinical case: We present a case of a 29-year-old female who was followed up in our Endocrinology Department. Past medical history included the diagnosis of Cushing Disease and transsphenoidal tumor resection at 12 years of age, followed by transcranial resection two years later because of persistently elevated adrenocorticotropic hormone (ACTH). Despite the surgical management, the patient persisted with increased ACTH and hypercortisolism, so bilateral adrenalectomy was performed a year later. Two years after the procedure, the patient presented with a newly diagnosed pituitary macroadenoma, so the diagnosis of Nelson Syndrome was made. Linear accelerator radiotherapy was given, which reduced the size of the tumor. Later, multiple imaging studies showed multiple lesions on the falx cerebri, posterior clinoid process, retroclival region, cerebellopontine angle, pterygopalatine fossa, infratentorial region, and posterior ethmoidal cells. Biopsy and immunohistochemistry of the falx cerebri lesions described ACTH-producing pituitary adenocarcinoma. Treatment was given with intramuscular octreotide, dabrafenib, and trametinib. Despite persistently elevated ACTH levels, the patient has since remained clinically stable, without new development or worsening of symptoms. Conclusion: There are 3 unique aspects of our case. First, we reported an unusual presentation of this disease, because the patient in our case was a female with an early age of onset, in contrast with the reported literature. Second, this is the first reported case demonstrating pituitary carcinoma in the falx cerebri. Third, the prognosis of pituitary carcinoma is very poor, and mortality is extremely high, however, the patient in our case has been followed up for 7 years since the diagnosis of the metastatic lesions and has remained clinically stable.

From breast cancer diagnosis to survivorship: analyzing perioperative biopsychosocial phenotypes and their relationship to pain on long term.

Persistent breast cancer treatment-related pain affects up to 40% of patients, decreasing their quality of life (QoL). While current research typically utilizes correlation and regression analysis to identify biopsychosocial phenotypes contributing to this pain, this study employs cluster analysis to identify qualitatively different phenotypes based on somatosensory and psychosocial characteristics both before and one week post-breast cancer surgery. Further, it investigates how these phenotypes are related to pain intensity one year post-surgery and examines the evolution of phenotype membership from pre- to post-surgery. Somatosensory and psychosocial functioning was evaluated pre- and post-surgery in 184 women undergoing unilateral breast cancer surgery. Eight different quantitative sensory testing (QST) methods including mechanical detection and pain thresholds, pressure pain thresholds, thermal detection and pain thresholds, and conditioned pain modulation were performed at the surgical area (trunk, arm, major pectoral muscle) and a distant location (quadriceps muscle). Psychosocial functioning was assessed using the Central Sensitization Inventory, Pain Catastrophizing Scale, Depression Anxiety Stress Scale-21, and the McGill Quality of Life Questionnaire. Pain intensity was evaluated one year post-breast cancer surgery using the Visual Analogue Scale. Latent class analysis identified five distinct phenotypes before and post-surgery, characterized by differences in mechanical and pain thresholds alongside psychosocial factors. Moreover, higher psychosocial distress and lower QoL correlated with elevated pain intensity one year post-surgery. These findings underscore the importance of addressing breast cancer patients' mental health perioperatively. Therefore, future research should explore whether psychological interventions perioperatively can reduce long-term pain intensity. PerspectiveThis secondary analysis, utilizing cluster analysis, reveals five distinct phenotype based on somatosensory and psychosocial characteristics both before and post breast cancer surgery. Higher psychosocial distress and lower quality of life correlated with elevated pain intensity one year post-surgery, emphasizing the need to address patients' mental health perioperatively. Trial registrationclinicaltrials.gov (NCT03351075)

Revolutionizing Rural Health Care: The Power of Telehealth and Digital Health Literacy

Abstract For many living in remote areas, accessing quality health care remains a significant hurdle. Long distances, limited specialists, and transportation challenges create a gap in care that telehealth has the potential to bridge. This article explores how telehealth, the use of telecommunication technologies for health-care delivery, can revolutionize rural health care. Telehealth consultations can connect patients with specialists in distant locations, reducing travel burdens and wait times. It can also enhance preventative care through remote monitoring and medication management. However, the success of telehealth hinges on digital health literacy. Equipping rural communities with the skills to navigate these technologies is crucial for maximizing their benefits. This article delves into the challenges and opportunities presented by telehealth in rural areas. It discusses how initiatives promoting digital health literacy can empower communities and ensure equitable access to quality health care. Ultimately, it argues that by embracing technological advancements and fostering digital literacy, we can create a future where location no longer dictates the quality of health care received.

Climatic Impact on the Air Pollutant Concentrations Emitted from Gas Stations in Fallujah, Al-Anbar, Western Iraq

The research investigates the influence of climatic elements like temperature, relative humidity, rainfall, evaporation, dust storms, wind direction, and speed on the air pollutant concentrations at gas stations in Fallujah city while examining their impact on humans and the environment. This was achieved by measuring concentrations of CO, NO2, and CH4, suspended particles (TSP, PM10), and Cu, and Pb. It was found that the impact increased in July compared to January, because of the influence of the measured climatic elements. Rising temperatures increase air pollutants' concentrations in the atmosphere, while winds spread them from emission sites to distant locations. Moreover, summer temperatures significantly impacted air pollutant concentrations at the study stations, particularly at Al-Rehab gas station, with the highest recorded temperatures of 48.4°C. Some gas stations also exceeded local environmental limits for TSP, PM10, CO, NO2, and Pb. The study revealed that summer temperatures with wind speeds of 2.1 m/s resulted in the highest air pollutants values, while winter temperatures with wind speeds of 1.9 m/s decreased these values. Higher temperatures increase chemical reactions and temperature inversions, leading to increased pollution concentrations and exacerbating air quality problems in the study area. Strong winds disperse pollutants, reducing concentration in the study area, while low wind speed increases concentrations and stagnation, resulting in poor air quality in the studied sites. The importance of the current study lies in evaluating pollutants in the Fallujah city, determining their causes, the extent of the impact, and contribution of natural and human sources in causing changes in air pollutant concentrations; caused by emission from the source. Moreover, the current study showed its impact on human’s health, and trying to find solutions to limit these effects or reduce their levels to ensure the safety of the environment and health.

Oral Microbiota and the Risk of Gastrointestinal Cancers-A Narrative Literature Review.

The human body is colonized by trillions of microorganisms in a symbiotic relationship. The oral cavity represents one of the most abundant microbial habitats in our body. Advances in sequencing techniques provide a more detailed understanding of the oral microbiota and how imbalances between bacteria, the phenomenon of dysbiosis, can affect not only the development of dental caries or inflammation within the oral cavity but also systemic diseases and cancers in distant locations. This narrative review evaluates the relationship between oral microbiota and its impact on gastrointestinal cancers. Using the keywords "oral microbiota 'AND' gastrointestinal cancers", the PubMed Web of Science and Scopus databases were searched for articles published between 2014 and 2024. Based on the review, the relationship between oral microbiota and oral, esophageal, gastric, colorectal, hepatocellular, and pancreatic cancers was described. Potential oncogenic mechanisms exploited by the microbiota such as the production of pro-inflammatory cytokines, induction of abnormal immune responses, and disruption of cell metabolic pathways were assessed. Further research and a thorough understanding of the impact of the oral microbiota on the development of cancers of the gastrointestinal tract may play a key role in their prevention, diagnosis, and treatment in the future.

Abstract B061: Bridging the gap in inequality in timely cancer diagnosis: GLORIA network Colombia

Abstract Introduction: In Latin American countries, survival rates for highly malignant tumors show disparities in access to diagnosis and treatment between small and big cities. Colombia is an example where the rate of pathologists is 0.88 per 100,000 inhabitants. Oncopathologists are predominantly situated in major cities, being a minimal percentage of this specialty. Whole slide imaging (WSI) technology can be used to mitigate disparities by facilitating diagnostic support for less-experienced pathologists in distant locations from expert centers. Telepathology brings a solution in bridging these gaps, enabling connectivity and facilitating timely diagnoses and treatments. To achieve this goal, a Colombian research group developed the GLORIA Colombia Network, which will provide WSI scanners and a telepathology network in small cities connecting them to an expert central laboratory. This will facilitate decision-making for oncopathological diagnoses. We aim to show a preliminary phase of the project; knowledge, attitudes, and practices of general pathologists operating the scanners are explored to delve into fears and expectations so that an introduction of this technology can be made. Methods:Introductory phase consisted of a semi-structured survey piloted by the research group and conducted via Google Forms for general pathology laboratories in Colombia, through the network ASOCOLPAT (Colombian pathologist association). There were 23 close questions related to context recognition, and an open question to explore qualitative aspects related to telepathology. ResultsA total of 51 responses from general pathologists were obtained, 100% stated they had needed assistance of a subspecialist in high complexity cases; 47% noted soft tissue tumors were challenging diagnoses, 35.2% affirmed hematological tumors were also challenging. The 25.5% reported stress high levels in complex diagnoses. 64% reported 1-10 complex cases/month in capital cities. The most frequently requested type of tumor for consultation was lymph nodes (21.3%), followed by melanocytic tumors (23.5%). Furthermore, 27.4% stated the response time for interconsultation ranged from one week to one month. Additionally, 79.2% of pathologists attempt to diagnose the case themselves, but if unable to do so, they refer it to a specialist. The open question revealed doubts about general pathologists' roles, and their feeling of undervalue compared to subspecialists. This question highlighted the need for training, and telepathology emerged as an alternative to facilitate communication between general pathologists and subspecialists. Emphasizing the importance lies in improving diagnostic times, which affects patients’ quality of life. Conclusion GLORIA network, bridges healthcare gaps by connecting general pathologists with specialists, enabling faster and accurate diagnoses. This initiative reduces stress, offers training, and improves diagnostic reliability, benefiting patients in remote areas with complex malignant tumors. Citation Format: Gabriela Guerron-Gomez, Maria C. Restrepo-Guarnizo, Andres Mosquera-Zamudio, Oscar Mendoza, John J. Sprockel, Arley Gomez, Laura D. Olarte Suarez, Merideidy Plazas Vargas, Rafael Parra-Medina, Marcela Gomez-Suarez. Bridging the gap in inequality in timely cancer diagnosis: GLORIA network Colombia [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B061.

Descriptive analysis of road traffic crashes encountered by Tanzanian motorcycle taxi drivers trained in first aid

IntroductionIn Dar es Salaam, Tanzania, death from road traffic crashes (RTC) occurs at roughly double the global rate. In this study, we sought to understand the locations and types of vehicles involved in RTC in Dar es Salaam encountered by a cohort of motorcycle taxi drivers previously trained in first aid. MethodsThis was a quasi-non-randomized interventional study, cohort subtype, with three-month follow-up. Some 186 motorcycle taxi drivers were selected by convenience sampling from 16 heavily populated, central wards and trained in a basic hemorrhage control course. Participants reported the location and types of vehicles involved in RTCs they encountered and intervened upon through performing bleeding control interventions. Surveys were designed on KoboToolbox and administered via phone call at monthly intervals over a three-month period. The main outcome measures were the location of crash encounters and types of vehicles involved. ResultsIn all 62 unique participants (33.3 %) encountered and provided bleeding control interventions to 83 injured individuals following 69 RTC in at least 31 distinct city wards, despite training only having occurred in 16 wards. Eight crash locations were not recorded. Crashes in distant wards typically contained major roads. Most commonly, crashes involved a motorcycle without the involvement of another vehicle (n=20), followed by motorcycle vs. car/three-wheeled vehicle (n=15), motorcycle vs. bus/van (n=10), motorcycle vs. motorcycle (n=9), motorcycle vs. pedestrian (n=7), pedestrian vs. bus/van (n=2), pedestrian vs. car/three-wheeled vehicle (n=1), motorcycle vs. bicycle (n=1), multi vehicle (n=1), and other (n=3). ConclusionsMotorcycle taxi drivers trained in hemorrhage control frequently encounter and intervene upon RTC in wards where they are based as well as in distant locations, commonly in wards containing major roads. Expanding first aid training for motorcycle taxi drivers could improve timely access to emergency care for RTC victims. Since most crashes involved motorcycles, road safety training should be integrated into future courses.

Recurrence of Hepatocellular Carcinoma after Liver Transplantation: Clinical Patterns and Hierarchy of Salvage Treatments

Introduction: The multiparametric nature of recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) still leads to uncertainty with its practical management. This study aims to characterize the main posttransplant recurrence patterns of HCC and to explore the therapeutic modalities targeting recurrence. Methods: Consecutive patients who underwent LT for HCC at a single tertiary center were analyzed. The time from first recurrence to death was investigated for each site of presentation. The impact of each recurrence-targeted treatment on survival was studied. Results: Of 660 patients with HCC, any recurrence occurred in 96 (15.4%) patients with a median time to recurrence of 20.0 months (95% CI: 15.6–23.8). Patients recurred across different patters including solitary distant locations (30.8%, n = 28), liver only (24.2%, n = 22), lung (18.7%, n = 17), multi-organ disease (17.6%, n = 16), and bone (8.8%, n = 8). Multi-organ and bone recurrences had the poorest survival, while solitary distant lesions and pulmonary recurrences had the best outcomes. Each treatment modality carried a distinctive survival. Conclusions: Patients recurred across 3 patterns with different prognostic implications. The benefit of each treatment option on distinct recurrence patterns appears to be influenced by the biological behavior inherent in the recurrence pattern itself.

Endometriosis – hormones and treatment

Abstract Endometriosis is a prevalent condition, affecting 10-15% of women of reproductive age and approximately 70% of those with chronic pelvic pain. An estimated 176 million women worldwide are affected by this disease. The condition occurs predominantly between menarche and menopause, with peak incidence between the ages of 25 and 45. Endometriosis is characterized by the presence of endometrial-like tissue outside the uterine cavity, leading to the formation of lesions most commonly in the ovaries but also in the fallopian tubes, gastrointestinal tract, and occasionally in distant locations like the pleura and central nervous system. Symptoms include chronic pelvic pain, heavy and painful menstrual periods, dyspareunia, painful urination, and defecation. Diagnosis involves a combination of medical history, physical examination, imaging techniques, and the gold standard, diagnostic laparoscopy. There is an average delay of 6.7 years between symptom onset and diagnosis, often due to variable and confusing symptoms resembling other conditions. The pathogenesis of endometriosis involves genetic, hormonal, and environmental factors, with significant roles played by estrogens and progesterone. Treatment strategies focus on managing symptoms through pain relief, hormonal therapy, and surgical interventions, although no permanent cure exists. Hormonal imbalances, particularly the interaction of progesterone and estrogens, play a crucial role in disease progression. Current research explores various treatment options, including hormonal therapy, nonsteroidal anti-inflammatory drugs, antioxidants, and surgical methods to improve the quality of life for patients.