Geographical Location Research Articles

Exploring Co-labeling Strategies in Local Food Markets: Insights from a Choice Experiment on Southern Buyers’ Preferences for Cherry Tomatoes

Labeling strategies are often discussed in the context of local food purchase. Substantial research has been undertaken to discern buyers’ preferences for different labeling strategies associated with a production practice or a geographic location. Some studies have also emphasized the substitution or complementarity effects that may occur across these different labels. Using a large choice experiment with 1820 respondents across six US southern states, this research evaluates buyers’ preferences for co-labeling strategies, focusing on the association of a production practice and certifications (USDA Organic and Certified Naturally Grown) alongside six different production locations, ranging from local to imported sources. We focus on pint baskets of cherry tomatoes, chosen due to their popularity among purchasers of fresh produce. Based on the results provided by a Bayesian Mixed Logit model, we derived the respondent-specific posterior distribution of the partworths associated with each production location and regressed each of those against demographic indicators. Our findings highlight that most buyers substitute between USDA Organic and Certified Naturally Grown (CNG), and a minority consistently opt for the same production practice option. In addition, we underscore that price, or an indication of origin predominantly guides nearly half of buyers’ choices. We find that the premium for CNG is slightly superior to the organic one. Last, older respondents and respondents with a higher degree of education value produce grown within their state over neighboring states and more distant origins.

An application (ePRO) -based patient reported outcomes of quality of life from an innovative cancer care delivery model.

e23176 Background: With the accessibility of smartphones, it has become possible to develop applications for patient-reported outcomes. Quality of life (QoL) is an important measure in oncology research. We developed a phone application that could use any standardized form to be filled in by the patient. Here, we report using the EORTC questionnaire, QLQ-C30, built into the application as a form for data collection from our ongoing district cancer care program, which offers support at government district hospitals in India using an alternate oncology work force. Methods: An application (ePRO) was created, which allows one doctor administrator to follow the patients. Once the application is downloaded, the patient opens the QoL questionnaire (QLQ-C30), built into the application, and completes it using a smartphone. The researcher downloaded the data in Excel format and analyzed it. The application was attempted at a tertiary cancer center and a public hospital district cancer unit. A cross-sectional study was conducted over six months in 2023.The data were analyzed using SPSS version 24. Results: The application was downloaded and activated on the smartphones of 441 patients. Patients completed the form available through the application. Of all the respondents, 229 (51.9%) were male and 212 (48.1%) were female. The mean QoL of the tertiary hospital was 69.29, with a standard deviation (SD) of 18.98.The QoL scores were 50.94 (SD 23.50) in district hospital 1 and 77.01 (SD 17.35) in district hospital 2. The difference between one district and the other was significant (p < 0.001). The symptom scale scores varied between district hospitals and other hospitals. Conclusions: This presentation serves two purposes: to validate a new patient-reported outcome application and to provide data on QoL from peripheral centers compared with tertiary centers. The use of technology is feasible and can help gather patient-reported outcomes easily. There appears to be a difference in the quality of life of patients from different geographical locations. [Table: see text]

Understanding the Future Competitive Advantages of the Construction Industry

Technological changes (such as Construction 4.0) in an organization cause the workforce to exhibit resistance to change, job redundancy, etc. Geographical location will no longer provide a competitive advantage, but resources will be the source of competitive advantage in the future, and these resources will be intangible, valuable, and not be easily imitated. The aim of this study is to provide an understanding of the future competitive advantages of organizations in the construction industry that could help the construction workforce easily adapt to technological changes. This study is based on resource-based theory and the ADKAR change management model. This study developed an ADREKA sequence for organizations to achieve future competitive advantage during technological changes in the construction industry. Hence, building social, relational, and human capital is necessary during technological changes to achieve competitive advantage for an organization and foster workforce adaptability to change.

Statewide burden of cancer attributable to alcohol use in the United States in the last three decades, projections of deaths to 2040: A benchmarking study.

10575 Background: Cancer stands as the 2nd leading cause of deaths and disability in the United States (US), and among the numerous contributing factors, modifiable risk factors play a significant role in exacerbating this burden. Within the spectrum of cancers, alcohol consumption ranks as the second leading attributable cause of death, as per the Global Burden of Disease Cancer Attributable Risk Factor Study. Methods: Employing the GBD protocol, we conducted an estimation of deaths, disability-adjusted life years (DALYs) attributable to cancer caused by alcohol consumption in the US. This comprehensive analysis was stratified by age, gender, year, and geographical location throughout the US, from 1990 to 2019. To project future trends, we utilized time-series regression techniques to forecast deaths until the year 2040. Results: The total number of cancer-related deaths in the US surged from 19,898 (95%UI: 17,791-22,149) in 1990 to 34,455 (30,542-38,388) in 2019. Concurrently, DALYs increased from 532,533 (480,249-586,646) in 1990 to 854,351 (764,549-949,378) in 2019, and YLLs rose from 501,639 (452,446- 554,400) in 1990 to 802,493 (717,123-891,789) in 2019. The highest annual percentage change (APC) in ASR for mortality was observed in West Virginia, with a 32% increase, followed by Tennessee at 27%. Conversely, the District of Columbia witnessed the most significant decrease, with a 30% reduction from 1990 to 2019. In terms of DALYs rates, the highest increases were observed in West Virginia (27%) and Oklahoma (21%). Males bore a greater overall burden compared to females, with an APC in deaths of 97% vs 40% and an APC in DALYs of 87% vs 26%. The highest number of deaths occurred in the 60-64 age group, with 5,228 cases in 2019, while DALYs reached 154,034 in the same year. Projections indicate that the total number of deaths is expected to increase by 49,230 by the year 2040. Conclusions: In 2019, cancer-related deaths attributed to alcohol use represented 4.42% of all cancer mortality cases. From both a public health and clinician perspective, the study's results highlight the urgent need for comprehensive strategies to address the growing burden of cancer associated with alcohol use. Efforts should focus on prevention, early intervention, and support for individuals struggling with alcohol-related cancer risks. [Table: see text]

Prevalence and Antibiogram of Escherichia coli Isolated from Children Under Five Years of Age Presented with Acute Diarrhoea: Cross Sectional Study from a Tertiary Care Centre in South India

Aim: The study aimed to analyze the prevalence and antibiogram of E. coli isolated from stool sample cultures collected from children below five years of age who were presented with acute diarrhoea in a tertiary care centre. Background: Multidrug-resistant strains of diarrheagenic E. coliremain a major public health concern for greater morbidity and mortality. Antibiotic resistance and susceptibility patterns of E. coli were found to vary with geographical location. Objective: To determine the prevalence and antibiogram of E. coli isolated from cultures of diarrhoea stool samples collected from children below five years of age from laboratory records. Methods: A cross-sectional study was designed to analyze the report on stool culture of children (aged below five years) presented with acute diarrhea during the period between 2017 and 2020. The prevalence of E. coli and its antibiogram were analyzed. The data were subjected to statis-tical analysis. Results: A total of 245 diarrhoea stool samples results were analyzed. E. coli was confirmed in 176 samples (72%). More number of isolates (51/176, 28.9%) were found in children below one year of age with male dominance. Amoxicillin resistance was found in all the E. coli strains isolated with no significant difference (p=0.2233) between genders and age groups below and above one year. A significant difference (p=0.0001) was found between male and female chil-dren of age below and above one year for cefotaxime and ciprofloxacin resistance. Polymyxin B (72%) followed by imipenem (69%) sensitivity was exhibited by the isolated E. coli strains. Conclusion: E. coli isolates were more sensitive to polymyxin B and imipenem while they were most resistant to amoxicillin. Effective antibiotic treatment strategies should be developed to control E. coli infections in children.

Decentralized trial recruitment methods to facilitate broad coverage across urban and rural counties for a blood-based test in early colorectal cancer detection.

1607 Background: Based on the 2022 census, 20% of the U.S. population lives in rural areas. Recent literature suggests that individuals in these areas may encounter health disparities, potentially leading to higher mortality from colorectal cancer (CRC) when compared to their urban counterparts. The PREEMPT CRC is a prospective, multicenter clinical study designed to validate an investigational blood test (MyTectCRC) intended to provide a convenient and accessible option for CRC screening. PREEMPT CRC included a decentralized clinical trial (DCT) site to broaden enrollment from a wider range of geographical areas, including traditionally underrepresented rural regions. This analysis evaluates demographic characteristics of participants from rural and urban areas enrolled in two distinct strategies within the DCT sites. Methods: Eligibility criteria for PREEMPT CRC have been previously described (NCT04369053). All DCT activities occurred under one clinical study ‘Metasite’, enabled by a multichannel recruitment strategy that included 1) Direct-to-Participant (DTP) via digital enrollment and 2) Site-Based (SB) partners who supported the principal investigator by identifying participants scheduled to receive a screening colonoscopy. Participant zip codes were mapped to local counties and aligned with either 1) Metropolitan (Urban) or 2) non-Metropolitan (Rural) counties. Enrolled participants were analyzed for demographics and lifestyle behaviors such as tobacco, alcohol, and drug use. Results: The DCT site enrolled 12,137 participants, where 7,634 used DTP and 4,503 used SB. Of all DCT participants, 24.4% resided in rural areas. DTP's rural population recruitment (27.8%) was double that of the SB (13.5%). The female and male distribution was similar across the groups. A larger percentage of participants from underrepresented races overall were enrolled from urban areas; however, there were some noticeable trends in the rural population. For participants who resided in rural areas and reported their race, 12.5% of DTP participants were Black and 1.2% were Asian, compared to 9.6% and 1.2%, respectively, in SB. For participants in rural areas who reported ethnicity, within DTP, 5.1% identified as Hispanic/Latinx, compared to 14.3% Hispanic/Latinx in SB. Lifestyle behavior factors were similar between DTP and SB participants who resided in rural and urban areas. Conclusions: Through the use of a DCT, the PREEMPT CRC study reached rural areas especially through DTP methodology. Furthermore, the use of SB versus DTP showed certain shifts in demographics, these differences highlight the effectiveness of targeted outreach strategies and reflect the importance for integration of multiple methods and tools to enhance essential population characteristics across geographical locations. Clinical trial information: NCT04369053 .

Two-Layered Multi-Factor Authentication Using Decentralized Blockchain in an IoT Environment.

Internet of Things (IoT) technology is evolving over the peak of smart infrastructure with the participation of IoT devices in a wide range of applications. Traditional IoT authentication methods are vulnerable to threats due to wireless data transmission. However, IoT devices are resource- and energy-constrained, so building lightweight security that provides stronger authentication is essential. This paper proposes a novel, two-layered multi-factor authentication (2L-MFA) framework using blockchain to enhance IoT devices and user security. The first level of authentication is for IoT devices, one that considers secret keys, geographical location, and physically unclonable function (PUF). Proof-of-authentication (PoAh) and elliptic curve Diffie-Hellman are followed for lightweight and low latency support. Second-level authentication for IoT users, which are sub-categorized into four levels, each defined by specific factors such as identity, password, and biometrics. The first level involves a matrix-based password; the second level utilizes the elliptic curve digital signature algorithm (ECDSA); and levels 3 and 4 are secured with iris and finger vein, providing comprehensive and robust authentication. We deployed fuzzy logic to validate the authentication and make the system more robust. The 2L-MFA model significantly improves performance, reducing registration, login, and authentication times by up to 25%, 50%, and 25%, respectively, facilitating quicker cloud access post-authentication and enhancing overall efficiency.

β-lactamase and Plasmid-mediated Quinolone Resistance Determinants Among Proteus spp. Isolates at a Tertiary-care Hospital in Kolkata, India

Background: Emerging antibiotic resistance (ABR) in Proteus spp., especially to third-generation cephalosporins (3GCc), carbapenems, and fluoroquinolones, challenges the treatment outcome and infection prevention. Limited studies pose a knowledge gap between them and ABR. Methods: We investigated the in vitro efficacy of therapeutic options and prevalence of β-lac-tamase and plasmid-mediated quinolone resistance (PMQR) traits in 3GC- and/or fluoroquino-lone-nonsusceptible Proteus (P.) spp. (n=27) in Kolkata, India, during 2021–2022. P. mirabilis was commonly isolated (>80%) from superficial and urine samples. The majority of the isolates (48-78%) remained susceptible to piperacillin-tazobactam, meropenem, amikacin, cefoperazone-sulbactam, and cefepime. Results: All isolates showed >0.2 multiple-antibiotic resistance index, with >65% being multi-drug and >30% being extensively drug-resistant. blaTEM (n=9), blaNDM (n=9), and qnrA (n=6) were commonly noted with the co-production of β-lactamases and PMQR in ten (37%) isolates. More than 50% of the isolates were devoid of the tested acquired genes. Conclusion: The study concludes that superbugs dominate, with limited occurrence of plasmid-borne markers in this geographic location.

Does haze-related sentiment affect income inequality in China?

We investigate the effect of haze-related sentiment on urban–rural income inequality of prefecture-level cities in China. Income inequality is captured by the Theil index, the ratio and the difference between urban–rural income. We use GPT-3.5 models to conduct the sentiment analysis on the haze-related posts retrieved from the Weibo platform from 2018 to 2021. The generated emotion score and the number of posts are used to construct the haze-related sentiment measure. We find that haze-related unhappiness exacerbates urban–rural income inequality. The net population flow is investigated as the mechanism, indicating that negative sentiment reduces the net flows of both the floating population and resident population and consequently increases income inequality. The heterogeneity analysis finds that the effects of haze-related unhappiness on income inequality are smaller in cities with more hospital beds, doctors, and green spaces. Furthermore, the effects of the sentiment measure on income inequality vary significantly across cities in different geographic locations.

Deciphering the global landscape of breast cancer in 38 OECD countries from 1990-2019: A benchmarking global analysis.

1046 Background: Breast Cancer (BC) stands as the primary contributor to disability and the second leading cause of death among countries belonging to the Organization for Economic Cooperation and Development (OECD). A comprehensive cross-country analysis of BC is crucial to monitor the growing burden. Methods: Employing the global burden of disease framework, we have calculated the incidence, prevalence, mortality, disability-adjusted life years (DALYs), and years of life lost (YLL) attributed to BC, categorized by age, gender, year, and geographical location across the 38 OECD member countries. Results: The total number of BC cases has witnessed a notable increase, rising from 5.5 million (95%UI: 5.1-6) in 1990 to 9 million (8.2-9.8) in 2019. BC-related deaths have also risen from 172,148 (164,284-176,147) in 1990 to 214,458 (195,692-226,347) in 2019, while DALYs have increased from 4.6 (4.5-4.8) in 1990 to 5.1 (4.8-5.5) in 2019. The annual percentage change (APC) in incidence has surged by 59% (44-75%) from 1990 to 2019. The highest APC in age-standardized incidence rates was observed in South Korea at 150% (99-205), while the most substantial decrease was recorded in Switzerland at 3%. Regarding death rates, Japan saw an 11% increase, Costa Rica 10%, Mexico 9%, South Korea 8%, and Turkey 4%, whereas the remaining countries witnessed a decrease from 1990 to 2019. In terms of DALY rates, Mexico and Japan experienced a 10% increase, South Korea 5%, Turkey 3%, with the rest showing a decrease from 1990 to 2019. Males bore a higher burden compared to females, with an APC in total incidence of 109% versus 58%, deaths at 73% versus 24%, and DALYs at 57% versus 10% from 1990 to 2019. The highest overall burden was observed in the 70+ age group, while the <70 and <20 age groups exhibited a decreasing trend. The total number of deaths is projected to continue increasing. Conclusions: In 2019, BC accounted for 6.64% of all cancer-related deaths and 7.9% of DALYs among women. Based on these findings, low-resource countries should consider reallocating funding to combat this burden, and public health policymakers need to prioritize surveillance and early screening efforts.

Prevalence of postnatal anxiety disorders in mothers of preterm infants: a systematic review protocol.

The objective of this systematic review is to evaluate and synthesize the available evidence on the prevalence of postnatal anxiety disorders in mothers of preterm infants within 12 months of delivery. Mothers of preterm infants report more postpartum psychological problems than other mothers. Anxiety disorders are among the most frequently reported manifestations, and affect the quality of maternal care and the baby's development. However, data on the prevalence of postnatal anxiety disorders in mothers of preterm infants are inconsistent and imprecise. It is, therefore, necessary to estimate the prevalence of anxiety disorders among mothers of premature infants in order to develop appropriate interventions for screening, support, and treatment. This review will consider studies conducted in any setting and any geographical location that report on the prevalence of any anxiety disorders in mothers of preterm infants within 12 months of delivery. Any analytical or descriptive observational studies and experimental or quasi-experimental studies will be included. MEDLINE (Ovid), PsycINFO (Ovid), Embase (Elsevier), CINAHL (EBSCOhost), Google Scholar, MedNar, and the World Health Organization website will be searched for studies written in English or French. Screening, critical appraisal, and data extraction will be performed by 2 independent reviewers using the relevant JBI systematic review tools. The findings will be presented in narrative format, including tables and figures to aid in data presentation. PROSPERO CRD42023428202.

Bridging the gap: Leveraging AI to enhance access to clinical trials for underrepresented and underserved populations with cancer.

e13701 Background: National guidelines emphasize the crucial role of clinical trials (CTs) participation for all cancer patients. Despite this, significant barriers hinder access, particularly for underrepresented populations. Patients encounter obstacles such as geographic disparities and limited knowledge of tumor genetics, which impact their access to innovative CTs in metropolitan areas and academic centers. Furthermore, the increasing requirement for specific genetic profiles poses an additional challenge. This study aims to assess the impact of digital health platforms on improving access to CTs, with a specific focus on barriers related to ethnicity, geographic location, and disease knowledge. Methods: Leal (formerly, Trialjectory) is an AI-based platform that matches cancer patients to CTs based on self-reported medical profiles. The study included a diverse cohort of 39,031 users who completed the questionnaire. The patients’ geographic distribution across the US was analyzed, considering proximity to medical/academic centers, willingness to travel, and disease knowledge. Additionally, we examined genetic testing and biomarker knowledge across various clinical and sociodemographic groups. Results: The digital platform significantly improved geographic and ethnic diversity among CT seekers. Compared to industry standards of as low as 3% CT diversity, nearly a quarter of platform users were non-whites. Users outside major metropolitan areas, where CT enrollment is traditionally lower, were also better represented. Markedly, non-whites reported a lower willingness to travel outside their residence for CT participation compared to their white counterparts (p < 0.0001). A gap in disease knowledge was more evident in minority groups (p < 0.0001), with African Americans having a lower probability of knowing their mutation status compared to other ethnic groups. Conclusions: Access to CTs is hindered by barriers such as ethnicity, location, and knowledge. AI-based platforms swiftly identify and resolve these issues, empowering healthcare and support organizations to address individual patient concerns and boost diversity in CTs. AI analysis pinpoints underrepresented populations and regions with limited trial access, paving the way for tailored education and support initiatives to encourage informed decision-making. Strategically establishing trial sites in relevant areas addresses limited travel willingness due to cultural or socioeconomic constraints. AI technologies offer a promising approach to mitigate disparities, improve disease knowledge, ensuring equitable CT access, and enhancing healthcare outcomes for underrepresented populations.

The impact of socioeconomic status on gastrointestinal cancer care delivery in southeast Texas.

e15579 Background: Gastrointestinal (GI) cancers are a leading cause of cancer deaths in the US with an estimated 1,038,410 new cases and a 30.4% mortality rate in 2023. Disparities in cancer care are well documented and result from several variables, including socioeconomic status (SES), behavioral, and biological factors. We conducted a retrospective population-based cohort study aimed to investigate the relationship between various socioeconomic factors and delays in cancer treatment initiation, emphasizing the impact of gender, race, age, and geographical distance on the time to treatment initiation (TTI). Methods: We identified patients with colorectal, hepatobiliary, small intestinal, and gastroesophageal cancers, who received their cancer diagnosis and initiated treatment at Baptist Hospitals of Southeast Texas in Beaumont, Texas between January 2012, and December 2017. SES data, including age, sex, race, geographical distribution, insurance status, cancer staging, and treatment were collected. Logistic regression was performed to determine risk association by calculating odds ratios with 95% confidence intervals, as well as p-values to determine significance. The primary outcomes of interest were the overall survival (OS) rate, and TTI defined as the time interval between the confirmed cancer diagnosis and initiating the first treatment modality. Results: A total of 517 GI cancer patients were included in this study, with 359 comprising a cohort of patients with colorectal cancer. The majority of patients included were ; caucasians(%) males (%).. African American patients were significantly more likely to receive delayed treatment, Odds Ratio (OR): 5.89, 95% confidence interval (CI) 4.02-8.62, especially compared to the odds for similar Caucasian patients (OR: 0.16, CI: 0.11-0.23). When compared to younger counterparts, patients above the age of 80 were found to have poorer odds of prolonged survival (OR: 2.91, CI: 1.80-4.72). Patients who lived 30 miles away or further from our hospital had longer TTI compared to those living within 30 miles radius (OR: 1.85, CI: 1.19-2.87), a risk which remained significant within the colorectal cancer cohort (OR: 2.20, CI: 1.29-3.74). Patients with Medicare insurance showed longer TTI (OR: 1.50, CI: 1.01-2.23), and decreased OS (OR: 1.79, CI: 1.05-3.06)). No statistically significant difference was observed based on gender. Conclusions: Age, geographical location, and racial SES variables contribute to the disparities in GI cancer care in our community. Addressing these disparities and implementing targeted interventions to mitigate the impact of socioeconomic barriers is imperative to ensure equitable access to timely and effective cancer care, ultimately leading to improved patient outcomes and cancer survival rates.

Exploring determinants of freeway service area usage in the context of sustainable and collaborated development for transport and tourism

Freeway service areas (FSA) provide a variety of services for road users, but these services in some cases do not guarantee the satisfaction of road users. Understanding the factors that affect the satisfaction of FSA is crucial for transportation and tourism-related departments. This paper uses a structural equation model (SEM) to examine the relationships between geographical location, routine function and satisfaction with FSA, in the context of six representative FSAs in Shaanxi province, China. The samples are divided into three clusters to investigate the sensitivity of tourists with different travel demands to the above relationship. In addition, the ordered logit model is used to verify the results of SEM and analyze the influencing factors of FSA satisfaction. Results indicate that increasing attraction levels of transport and tourism are considered to be the key determinants in improving the satisfaction with FSA, and policies and suggestions should meet tourists’ different demands. Undifferentiated policies, while useful to help improve satisfaction with FSA, may have a negative impact on some certain groups, such as those on an official business trip. This study provides theoretical and practical insights into how relevant departments and organizations with respect to transport and tourism formulate strategies for the construction and sustainable development of FSA.

Do Climate Conditions Affect the Quality of the Apiaceae Fruits’ Essential Oils?

This study investigated the impact of climate conditions on the quality of essential oils extracted from Apiaceae fruits, specifically coriander (Coriandrum sativum var. microcarpum), aniseed (Pimpinella anisum), and annual caraway (Carum carvi var. annuum) grown at three distinct locations in Serbia over three consecutive years. Field experiments were conducted, and essential oils were extracted using a Clevenger-type apparatus followed by gas chromatographic–mass spectrometric analysis for compound identification. Weather conditions during the vegetation periods were recorded, and statistical analyses, including principal component analysis (PCA) and correlation analysis, were performed to assess the volatile compound compositions. Results indicate significant correlations among various compounds within each fruit type, with distinct patterns observed across different years. PCA further elucidates the influence of both year and sampling location on the chemical profiles of essential oils. Cluster analysis reveals clustering primarily based on the year of cultivation rather than geographical location, emphasizing the dominant role of weather conditions in shaping essential oil compositions. This study highlights the intricate relationship between climate conditions and the quality of essential oils in Apiaceae fruits, providing valuable insights for optimizing cultivation practices and enhancing essential oil production. In general, climate conditions strongly influence the coriander, anise, and annual caraway cultivation, and also essential oil quality.

The relative importance of precipitation change and temperature sensitivity in determining the population viability of a threatened sub‐tropical rainforest endemic plant Triunia robusta (Proteaceae)

AbstractThreatened species in rainforests may be vulnerable to climate change, because of their potentially narrow thermal tolerances, small population sizes, restricted distributions and limited dispersal. We investigated the relative influence of potential climate change on the population viability of Triunia robusta (Proteaceae), an endangered rainforest shrub endemic to southeast Queensland, Australia. A spatially explicit, stochastic population model with seven stage classes was developed and linked with the species distribution model (SDM) to explore a variety of hypothetical climate change simulations over a 90‐year period from 2010 to 2100: (1) constant population dynamics, (2) changes in habitat distributions as trend in carrying capacity and (3) changes in habitat distributions, precipitation and temperature regime as relative change in seedling survival and fecundity. The results revealed high vulnerability of small populations to local extinction regardless of geographical location or climatic stressors, while some larger populations located in the southern end of the species distribution range showed persistence in‐situ. Triunia robusta was found to be sensitive to reduced precipitation and increased temperature, limiting the species reproductive activities and seedling establishment and reducing the overall abundance consequently. Integration of population models and SDM allowed for the evaluation of multiple climatic stressors that may affect habitat distributions and population dynamics of T. robusta and ultimately suggest potential implications for future conservation and management planning with respect to climate change.

Quality of telehealth-provided cancer care in VA.

1633 Background: As the largest integrated health care system in the United States, the Veterans Health Administration (VA) has extensive experience in utilizing telehealth-(TH) to deliver care to the 10 million enrolled Veterans, including the~50,000 patients newly diagnosed with cancer annually and ~500,000 cancer survivors. The VA National TeleOncology (NTO) service was established in 2020 to provide specialized treatment regardless of geographical location. We sought to compare quality in TH-delivered care compared to traditional (TR) in-person VA care. Methods: Using the VA EHR, we identified patients who had an ICD-10 diagnostic code for an incident malignancy from Dec 2016 to March 2021 at three medical centers providing both TR and TH care. We used EHR review to classify patients as TH users, if they received TH services at least once for their cancer care, or TR care if no telehealth was used. Using both structured EHR data and manual review by two trained abstractors, we gathered demographic, clinical, and treatment characteristics to calculate 25 Quality Oncology Practice Initiative (QOPI) measures in the domains of symptoms and toxicity management (2), end of life and palliative care (10), and core measures (13). We report QOPI measures descriptively; and used chi-squared tests with alpha = 0.05 to compare TH and TR. Results: We identified 972 patients with lymphoma, prostate, lung or colorectal cancer. 427 (44%) were TH users and 545 (56%) were TR, and they were predominately white (n=819, 84.3%) men (n=930, 95.7%). TH users had better (n=13), worse (n=9), same (n=2) and unevaluable (n=1) descriptive performance on measures. For example, TH and TR were similar in administration of appropriate antiemetic therapy for high and moderate-risk antineoplastic agents (44.8% vs 42.4%). TH performed better than TR for chemotherapy summary being completed within three months of chemotherapy ending (83.4% vs 75.6%) and for emotional well-being being assessed by the second office visit (92.3% vs 89.9%). Appropriate tobacco use cessation administration within the previous year was statistically higher in TH (85.3% vs 76.2% p=0.0021). No differences were statistically significant for any other QOPI measures. Conclusions: VA is a leader in TH cancer care because of both its volume and quality. VA-provided TH cancer care quality is similar to or better than that of TR in-person care. NTO specifically, and VA teleoncology broadly, provides another option to Veterans for cancer care.

Temporal and spatial dynamics within the fungal microbiome of grape fermentation.

Over 6 years, we conducted an extensive survey of spontaneous grape fermentations, examining 3105 fungal microbiomes across 14 distinct grape-growing regions. Our investigation into the biodiversity of these fermentations revealed that a small number of highly abundant genera form the core of the initial grape juice microbiome. Consistent with previous studies, we found that the region of origin had the most significant impact on microbial diversity patterns. We also discovered that certain taxa were consistently associated with specific geographical locations and grape varieties, although these taxa represented only a minor portion of the overall diversity in our dataset. Through unsupervised clustering and dimensionality reduction analysis, we identified three unique community types, each exhibiting variations in the abundance of key genera. When we projected these genera onto global branches, it suggested that microbiomes transition between these three broad community types. We further investigated the microbial community composition throughout the fermentation process. Our observations indicated that the initial microbial community composition could predict the diversity during the early stages of fermentation. Notably, Hanseniaspora uvarum emerged as the primary non-Saccharomyces species within this large collection of samples.

Geographic and sociodemographic variations in disease burden, epidemiological trends, and risk factors of early-onset lung cancer: A global analysis.

11169 Background: Exploring the emerging trend of early-onset lung cancer (EOLC) burden is pivotal for guiding the implementation of preventive strategies among young adults. We aimed to provide a comprehensive examination of the geographic and sociodemographic variations in the disease burden, along with epidemiological trends and risk factors associated with EOLC over the past three decades. Methods: EOLC refers to lung cancer diagnosed in individuals aged 20-49 years. Utilizing the GBD 2019 data, we estimated the age-standardised incidence, mortality, and disability-adjusted life years (DALYs) rates for EOLC by sex, socio-demographic index (SDI) quintiles, and geographical location for the period from 1990 to 2019. We investigated the relationships between concomitant risk factors and EOLC incidence at national level, and calculated the DALYs attributable to risk factors. The relative contribution of population growth, population ageing, and epidemiological changes to the variations in burden of EOLC over study period was measured using the decomposition analysis. Incidence was forecast to 2040 using the Bayesian age-period-cohort model. Results: A total of 135,704 EOLC cases, equating to a age-standardised incidence rate of 4.0 (95% UI 3.6 to 4.3) per 100,000, were estimated in 2019 worldwide and was the second leading cause of cancer death among young adults, with higher disease burden occurred in males and those from middle and high-middle SDI regions. An overall decreasing trend in burden of EOLC was observed globally; such trends were more pronounced among males and followed a gradient across SDI levels, with the greater decrease observed in high and high-middle SDI regions. Sex, tobacco smoking prevalence, per capita cigarette-equivalent estimates, average age of smoking initiation, ambient ozone pollution, and GDP per capita were independently and significantly associated with EOLC incidence at the population level. Smoking remained the top contributor to burden of EOLC, with the exception of Andean Latin America, North Africa, and the low SDI regions, where ambient particulate matter pollution and household air pollution from solid fuels ranked as the foremost attributable risk factors. Population growth was the primary driver behind the global increase in EOLC cases in low and low-middle SDI regions, while epidemiological changes accounted for the most substantial reduction in EOLC cases across most regions. The global incidental cases of EOLC was projected to increase by 31.1% in 2040, with a more pronounced increase in females and those from high-middle and middle SDI locations. Conclusions: Our findings underscore significant geographic and sociodemographic disparities in the epidemiological burden of EOLC, emphasizing the necessity for policymakers to devise and apply region-specific, evidence-driven preventive strategies.

Disparities in head and neck cancer (HNC): An insight of the National Inpatient (NIS) database.

e13730 Background: Despite the decline in tobacco use, the incidence of head and neck cancers continues to increase in part due to HPV. HNC accounts for 4% of all cancers in the United States (USA), with particularly high morbidity in oncology. There is a complex interplay of factors that contributes to the incidence and prevalence of HNC; among these, sociodemographic characteristics and net income are notably linked to poorer outcomes within African American and Latino communities. Interestingly, despite a higher incidence in the White population, disparities persist. Consequently, there is a pressing need for a more nuanced characterization to comprehensively grasp the impact of sociodemographic factors on HNC outcomes. Methods: This was a retrospective cohort analysis of adults admitted to hospitals in the USA between 2016 and 2020 with a primary diagnosis of HNC. Data was obtained from the NIS Database, the largest publicly available inpatient database in USA, with over 7 million in-hospital stays per year. The primary outcome was to describe the trends of HNC, comparing sociodemographic characteristics. Secondary outcomes included the impact of being cared for in Teaching Hospitals (TH) vs. nonteaching hospitals (NTH) and length of stay (LoS). Hypothesis testing for categorical variables was tested with Chi-Square. Continuous variables were tested with a Student's t-test. Statistical significance was defined as a two-tailed P value of <0.05. Results: 191,740 patients met inclusion criteria: patients admitted between January 2016 and December 2020 under the primary diagnosis of HNC, corresponding to the billable code of the International Classification of Diseases 10th Revision, and patients 18 and older. Of all patients, 159,985 were admitted to TH and 31,755 in NTH. The most common geographic locations were the south region, 34% vs 46%, and the central region, 24% vs 20% for TH and NTH, respectively. The mean patient age was 62 in TH and 65.4 in NTH (p<0.001). The most affected sex was male. Hospitalization LoS (median) was 6.3 days in TH and 5.4 days in NTH (p<0.001). Furthermore, mortality was higher in NTH 7.51% vs 4.87% in TH (p<0.001). Most patients had a lower income: 50% in TH vs 62% in NTH had an income under the 50 bracket (p<0.001). White was the most common race among admitted patients (p<0.001). Chronic kidney disease, obesity, and coronary artery disease were significantly associated comorbidities (p<0.001). The two most commonly described complications during admission were AKI (p= 0.58) and mechanical ventilation (p=0.55). Conclusions: Low income is associated with higher mortality in patients with HNC. Socioeconomic determinants of health have been shown to have a predominant influence on outcomes over classic risk factors. Despite a greater LoS in teaching hospitals, this was inversely related to mortality, which could be associated with a more comprehensive diagnostic process and cancer-related care.