Block Group Research Articles

A Randomized Controlled Trial of Adding Deep Parasternal Intercostal Plane Block to Interpectoral-Pectoserratus Plane Block in Breast Cancer Surgery.

The interpectoral-pectoserratus plane block is expected to anesthetize the lateral breast, but it is unclear whether the deep parasternal intercostal plane block may enhance recovery by providing analgesia to the medial breast. Patients undergoing breast cancer surgery were randomly assigned to receive either the interpectoral-pectoserratus block (single block) or interpectoral-pectoserratus combined with deep parasternal intercostal block (combined block). The primary outcome was the quality of recovery-15 questionnaire score assessed at 24 hours postoperatively. Secondary measures included dermatomal block assessment, pain severity, opioid consumption, opioid-related adverse events, hospital length of stay, and chronic postsurgical pain at 3 months after surgery. One hundred and sixteen patients were recruited, 58 in the single block group and 58 in the combined block group. There was no important difference in the 24-hour quality of recovery scores with mean (standard deviation [SD]) 123.6 (6.3) in the single block group and 123.2 (7.1) in the combined block group (mean difference, 0.4; 95% confidence interval [CI], -2.0 to 2.9; P =.731). There was greater dermatomal block on medial breast in the combined block group. There were no differences in other secondary outcomes. Addition of deep parasternal intercostal plane block was not superior to interpectoral-pectoserratus plane block alone for the quality of recovery in patients undergoing breast cancer surgery.

Comparison of the clinical efficacy on chronic abdominal wall pain between trigger-point electroacupuncture and transversus abdominis plane block

To compare the clinical efficacy between trigger-point (TrP) electroacupuncture and transversus abdominis plane (TAP) block in treatment of chronic abdominal wall pain (CAWP). A total of 62 CAWP patients were randomly divided into a TrP electroacupuncture group (31 cases, 1 case dropped off) and a TAP block group (31 cases, 1 case dropped off). Electroacupuncture at trigger points was delivered in the TrP electroacupuncture group, and TAP block was administered under ultrasonic guidance in the TAP block group. Separately, the score of the numerical pain rating scale (NRS) was observed before treatment and in 1 week, 1 month and 3 months after treatment；the scores of the self-rating anxiety scale (SAS) and the self-rating depressive scale (SDS) observed before treatment and in 1 week and 3 months after treatment；and the score of the short form 36 questionnaire (SF-36) was observed before treatment and in 3 months after treatment. The utilization rate of remedial drugs was recorded during follow-up visit. The clinical efficacy was compared. At each time point after treatment, NRS score decreased in comparison with that before treatment (P<0.05), the scores of SAS and SDS 1 week and 3 months after treatment were reduced (P<0.05) and the each item score of SF-36 increased (P<0.05) 3 months after treatment of each group. Compared with the outcomes in the TAP block group, NRS scores were reduced 1 month and 3 months after treatment respectively (P<0.05), the scores of SAS and SDS decreased (P<0.05) and SF-36 score was elevated (P<0.05) 3 months after treatment in the TrP electroacupuncture group. There was no significant difference in the utilization rate of remedial drugs between the two groups. The clinical efficacy of the TrP electroacupuncture group (96.7%) was superior to that of the TAP block group (83.3%, P<0.05). Both TrP electroacupuncture and TAP block can markedly relieve pain, attenuate the emotional symptoms of anxiety and depression and improve the quality of life in the patients with chronic abdominal wall pain. The clinical efficacy of TrP electroacupuncture is better than that of TAP block 3 months after treatment.

The effect of erector spinae plane block on postoperative pain and quality of recovery in patients undergoing percutaneous nephrolithotomy

Percutaneous nephrolithotomy (PNL) is the preferred surgical procedure for treating renal stones larger than 2 cm. Patients may experience significant pain in the postoperative period due to factors such as the catheter entry site and tension in the renal capsule. Erector Spinae Plane (ESP) block provides perioperative muscle relaxation and reduces analgesic use. In this study, we investigated the effect of ESP block on postoperative pain scale and quality of recovery in patients undergoing PNL. The study was conducted with a total of 96 patients, with 45 patients receiving the ESP block and 51 patients not receiving the ESP block. Following the surgery, the visual pain scale (VAS) was completed at 0, 2, 6, 12, and 24 h, and the Quality of Recovery-15 (QoR-15) scale along with the willingness scale were completed at the 24-hour mark. The normal distribution of data was evaluated with the Kolmogorov-Smirnov test, histogram, and skewness-kurtosis coefficients. For comparing paired groups, the Student’s T-test was used for normally distributed variables, while the Mann-Whitney U test was used for parameters that did not have a normal distribution. The comparison of postoperative pain, as measured by VAS scores between the groups, revealed statistically significantly lower scores in the ESP block group at 0, 2, 6, 12, and 24 h (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.010, respectively). Our study results indicated that patients who received the ESP block experienced reduced pain levels and had higher QoR-15 scores compared to those who did not receive the ESP block.

Modeling evacuation activities amid compound hazards: Insights from hurricane Irma in Southeast Florida

Given the destructive nature of hurricanes in tropical regions, pre-disaster evacuation has emerged as a critical approach for hurricane preparedness. Nevertheless, the compounding effects of natural hazards and the outbreak of infectious diseases, such as Covid-19, significantly challenge hurricane evacuation management. To investigate emergency responses under compound hazards, this study develops an activity-based model to measure the evacuation behaviors of individuals, using Hurricane Irma as a case study. Four scenarios are designed, including a single hurricane hazard, Hurricane Irma compounded with a pandemic like Covid-19, Hurricane Irma compounded with flood damage to the transportation network, and a combination of all these hazards. The metropolis-hasting algorithm is utilized to generate a population with socioeconomic attributes, which is then allocated to census block groups covering Palm Beach, Broward, Miami-Dade, and Monroe Counties in Florida. Datasets from multiple sources are used to measure evacuation decisions, which are subsequently simulated using MATSim. The results highlight the potential impacts of compound hazards on transportation systems, including increased congestions in scenarios involving compounded hurricanes and floods, especially between 10 a.m. and 7p.m. Moreover, a higher proportion of socially vulnerable populations is observed in scenarios involving compounded hurricanes and pandemics, particularly in the Key West area. The developed model could be further applied to measure the indirect impacts of natural hazards on transportation systems.

Comparison of intrathecal fentanyl as an adjunct in spinal anaesthesia to ultrasound-guided quadratus lumborum block as an effective postoperative analgesia for Caesarean section surgery.

Postoperative pain in patients, if dealt with inadequately, has been a significant cause of morbidity. The present study compared the postoperative analgesic efficacy of intrathecal fentanyl and ultrasound-guided quadratus lumborum block following Caesarean surgery. A prospective randomised controlled study was planned for parturients who underwent Caesarean surgery under spinal anaesthesia. Patients received bupivacaine (10mg) and 25µg of intrathecal fentanyl in the spinal anaesthesia (group intrathecal fentanyl, n = 30) or 20mL of 0.375% ropivacaine bilateral quadratus lumborum block (group quadratus lumborum; n = 30) after surgery. The visual analogue scale score, quality of recovery-15 score and incidence of ill effects were recorded. The postoperative haemodynamic parameters were comparable between the two groups. The visual analogue scale score at different time intervals decreased after the quadratus lumborum block (p < 0.05). The mean global quality of recovery score was better in the quadratus lumborum group (p < 0.001). In the quadratus lumborum group, the mean time to first ambulation was lower than that in the intrathecal fentanyl group (p < 0.05). The requirement for first-rescue analgesia was earlier in the intrathecal fentanyl group (4.67 ± 0.72) than in the quadratus lumborum group (4.92 ± 0.88). Intrathecal fentanyl and quadratus lumborum block had effective postoperative analgesic effects on Caesarean surgery patients. However, the quadratus lumborum block group exhibited better analgesia and early ambulation than the intrathecal fentanyl group, with an improved quality of recovery.

Comparison of the analgesic effects of infraspinatus-teres minor interfascial block and interscalene block under ultrasound guidance in patients undergoing arthroscopic shoulder surgery

Objective: To compare the postoperative analgesic efficacy of ultrasound-guided infraspinatus-teres minor interfascial block and interscalene block in shoulder arthroscopic surgery. Methods: A total of 74 patients undergoing shoulder arthroscopic surgery at the Affiliated Hospital of Jiaxing University from December 2023 to February 2024 were prospectively included, whose age ranged from 18 to 80 years and the American Society of Anesthesiologists (ASA) grade were Ⅰ-Ⅲ. Patients were divided into two groups using block randomization: infraspinatus-teres minor interfascial block group (observation group) and interscalene block group (control group), with 37 cases in each group. In the anesthesia preparation room, all patients received nerve blocks under ultrasound guidance with 20 ml of 0.375% ropivacaine. Patient-controlled intravenous analgesia (PCIA) was administered to all patients following surgery. The primary outcome was the area under the curve (AUC) of the numeric rating scale (NRS) for pain within 24 hours postoperatively. Secondary outcome measures included the highest NRS score within 48 hours postoperatively, the amount of sufentanil used via PCIA within 48 hours postoperatively, the incidence of rescue analgesia and rebound pain, QoR-40 scores, and the rate of postoperative nausea and vomiting within 24 hours. The non-inferiority margin for the AUC of NRS scores between the two types of regional nerve blocks was set at "2.6". Results: A total of 35 patients were included in the observation group [17 males, 18 females, aged (58.1±9.1) years], and 36 patients were included in the control group [12 males, 24 females, aged (57.0±9.8) years]. The AUC of the NRS scores at rest within 24 hours post-operation was 51.7±10.9 in the observation group and 62.6±13.6 in the control group. The difference in AUC between the two groups was -10.9 (95%CI:-16.8--5.1), with the upper limit of the 95%CI falling below the predefined non-inferiority margin of "2.6" (non-inferiority P<0.001). The highest NRS score [M (Q1, Q3)] within 48 hours post-surgery was 3 (3, 4) in the control group, which was significantly higher than the observation group's score of 2 (2, 3) (P<0.001). During the postoperative period of 0-12 hours, the observation group received a median dose of 12 (10, 14) μg of sufentanil, which was significantly higher than the control group's dose of 8 (6, 10) μg (P<0.001). During the postoperative period of 12-24 hours, the observation group received a median dose of 8 (8, 10) μg of sufentanil, which was significantly lower than the control group's median dose of 12 (10, 14) μg (P<0.001). During the postoperative period of 24-48 hours, there was no statistically significant difference in the dose of sufentanil between the two groups of patients (P=0.548). In the observation group, the incidence of rescue analgesia within 48 hours postoperatively was 0 (0/35), which was lower than that of the control group at 22.2% (8/36) (P=0.010). The occurrence of rebound pain in the observation group was 0 (0/35), and the control group was 11.1% (4/36), no statistically significant difference was found between two groups (P=0.130). In the observation group, the QoR-40 score within 24 hours post-operation was 180.2±3.2, which was higher than the control group's score of 175.8±4.7 (P<0.001). There was no statistically significant difference in the incidence of postoperative nausea and vomiting within 24 hours between the two groups (P=0.372). Conclusion: Ultrasound-guided infraspinatus-teres minor interfascial block demonstrates a comparable analgesic effect to interscalene block in shoulder arthroscopic surgery within the first 24 hours postoperatively.

Petrogenesis of supracrustal rocks from the Maxianshan and Xinglongshan Groups in the eastern Central Qilian block: Constraints on the construction of Rodinia

Controversy has long surrounded the reconstruction of the East Asian blocks in the Rodinia supercontinent, which was a coherent large landmass during 900–750 Ma and is now dispersed over all current major continents. The Central Qilian block is a Precambrian microcontinent in the early Paleozoic Qilian orogenic belt, which marks the junction of the North China, South China and Tarim cratons. In this paper, we present a systematic study of the petrology, whole-rock geochemistry, and geochronology of supracrustal rocks from the Maxianshan Group and the Xinglongshan Group in the easternmost part of the block. The metasedimentary rocks from both groups overlie a gneissic granite, which has a zircon U-Pb age of 970 ± 6 Ma with εHf(t) values of −3.5 to + 2.5 and is an I-type granite formed in a back-arc setting. Paragneisses from the Maxianshan Group and micaschists from the lower formation of the Xinglongshan Group have detrital zircon U-Pb ages of 2465–876 Ma that peak at ca. 950 Ma. They show strongly decreasing zircon εHf(t) values of + 0.8 to −11.3 and ages from 1174 Ma to 876 Ma. Their protoliths constituted a sedimentary sequence with a long history of deposition during 1174–911 Ma in a continental arc-related basin. Metabasaltic tuffs from the middle formation of the Xinglongshan Group are tholeiitic with a zircon U-Pb age of 958 ± 9 Ma and indicate a back-arc setting. Metasandstones from the upper formation of the Xinglongshan Group have detrital zircon ages of 2668–732 Ma that peak at 810 Ma and 984 Ma and indicate a passive margin setting. Combining our results with existing data, we propose that the Maxianshan Group and the Xinglongshan Group make up an early Neoproterozoic trench-arc-basin system at a continental margin of Rodinia. Oceanic crust subduction underneath the continent at 1174–896 Ma with formation of a mature continental arc, and continuous subduction from 824 to 735 Ma with opening of the Proto-Tethys Ocean as a back-arc basin are suggested for the formation of the Central Qilian block.

Persistent Environmental Injustice due to Brake and Tire Wear Emissions and Heavy-Duty Trucks in Future California Zero-Emission Fleets.

The adoption of zero-emission vehicles (ZEVs) offers multiple benefits for the climate, air quality, and public health by reducing tailpipe emissions. However, the environmental justice implications of the nonexhaust emissions from future ZEV fleets for near-roadway communities remain unclear. Here, we model the on-road fine particulate matter (PM2.5) emissions across all California counties and assess the near-roadway exposure disparities at the census block group level in the Los Angeles County in 2050, when almost all passenger vehicles are projected to be ZEVs. We found that promoting zero-emission heavy-duty trucks generates more air quality benefits for disadvantaged communities than light-duty passenger vehicles. Persistent disparities in near-roadway PM2.5 levels, however, exist due to the remaining brake and tire wear emissions and increased truck traffic in disadvantaged communities. We recommend implementing fleet-specific ZEV policies to address brake and tire wear emissions and optimizing freight structures to address these persistent environmental justice issues in California.

Association of Neighborhood Socioeconomic Disadvantage with Proliferative Diabetic Retinopathy.

To evaluate the association between neighborhood socioeconomic deprivation, distance from ophthalmology clinics, and diagnosis of proliferative diabetic retinopathy (PDR). Retrospective cohort study. Adult patients (≥18 years) with diabetes mellitus at Johns Hopkins Hospital and University of Wisconsin-Madison. Patient addresses were geocoded and the block group was linked to the 2021 national Area Deprivation Index (ADI). ADI was divided into quartiles, with higher quartiles indicating greater socioeconomic disadvantage. The distance between patient's residence and ophthalmology clinics was calculated. Multivariable logistic regression models were used to analyze the association between ADI quartile, distance from clinic, and PDR, adjusted for demographics and insurance status. The interaction between ADI and distance was tested. Diagnosis of PDR. 73,618 patients were included. A significant interaction was observed between ADI quartile and distance from ophthalmology clinics (P < .001). Among patients residing within 8 miles of clinics, those in higher ADI quartiles had increased odds of PDR compared to those in ADI Q1 (Q2: OR 1.36, 95% CI 1.12-1.65; Q3: OR 1.79, 95% CI 1.46-2.19; Q4: OR 2.60, 95% CI 2.09-3.25; P<.001 for trend). Conversely, for patients living more than 8 miles from clinics, the odds of PDR were similar across ADI quartiles (Q1: OR 0.85, 95% CI 0.73-0.98; Q2: OR 1.02, 95% CI 0.87-1.12; Q3: OR 1.08, 95% CI 0.90-1.30). However, patients in all ADI quartiles more than 8 miles had greater odds of PDR compared to those in the same ADI quartile within 8 miles (OR 3.15, 95% CI 2.61-3.80, OR 1.97, 95% CI 1.71-2.27, OR 1.79, 95% CI 1.51-2.12, and OR 1.31, 95% CI 1.07-1.61 in ADI Q1 to Q4 respectively). Patients living in neighborhoods with greater socioeconomic disadvantage and further from ophthalmology clinics have greater odds of PDR. These findings suggest the potential utility of targeted interventions in socioeconomically deprived and distant areas to reduce PDR-related blindness.

From roads to roofs: How urban and rural mobility influence building energy consumption

Understanding the relationship between travel behavior and building energy use at an urban scale is crucial for developing effective energy management strategies. Mobility patterns significantly impact building occupancy, which in turn affects energy consumption. However, existing methods often focus on individual buildings, whereas geographical influences on energy usage are not adequately examined. This study addresses this gap by using transportation origin-destination (OD) data to estimate building occupancy and energy. The proposed method assigns OD trips from census block groups to the building level, incorporating building, travel survey, and census data to derive building occupancy profiles. This method was applied to urban and rural areas with 4062 buildings in 70 census block groups. We found that the OD-informed occupancy profile exhibits smoother energy consumption patterns compared with that of Department of Energy reference occupancy profiles. Our analysis reveals distinct building energy consumption patterns among groups with long and short commutes, emphasizing the effect of commute times and work schedules on residential energy usage. This framework is useful for practitioners in transportation agencies and utility companies, enabling the estimation of building energy based on mobility patterns. Overall, this study shows the potential of integrating transportation and building energy data to inform cross-sector energy management strategies.

Comparison of ilioinguial/iliohyphogastic nerves block with wound-infiltration on postoperative pain – a randomised controlled trial

Objective: To compare postoperative pain scores at rest and on movement in patients undergoing open inguinal hernia repair between those receiving illioinguinal/illiohypogastric nerve block with ropivacaine or wound infiltration with ropivacaine. Method: The randomised clinical trial was conducted at the Department of Anaesthesiology, Aga Khan University Hospital a tertiary care centre from March to August 2019 and comprised patients of either gender scheduled for elective unilateral open inguinal hernia repair under general anaesthesia. They were randomised into illioinguinal/illiohypogastric nerve block group A, and wound infiltration group B. In group A, 20ml of 0.25% ropivacaine was infiltrated in the vicinity of the nerves under ultrasound guidance, while group B received wound infiltration with ropivacaine 10ml 0.25% at the end of surgery. Postoperative static and dynamic pain was assessed at 0, 2, 6, 12 and 24 hours using visual analogue scale. Total usage of opioids in 24 hours postoperatively in both groups, patient satisfaction and complications were recorded. Data was analysed using SPSS 19. Results: Of the 60 patients, 30(50%) were in each of the 2 groups. There were 29(96.7%) males and 1(3.3%) female in group A with mean age 45.63±17.43 years, and 28(93.3%) males and 2(6.7%) females in group B with mean age 49.33±15.39. The mean pain score at rest was not significantly different between the groups (p&gt;0.05). On movement, the mean pain score between the groups was different only at 6 hours (p=0.02). There were no significant intergroup difference in total usage of opioids in 24 hours postoperatively and patient satisfaction (p&gt;0.05). Conclusion: Illioinguinal/illiohypogastric nerve block and wound infiltration with ropivacaine were found to be equally effective methods in controlling postoperative pain. ClinicalTrials.gov ID: NCT04462510. Key Words: Local anaesthesia, Inguinal hernia, Pain management, Patient satisfaction.

Uncovering disparities in water-based outdoor recreation using cell phone mobility data

Abstract Outdoor recreation plays a pivotal role in improving people’s physical and mental health, serving as a popular form of entertainment and a significant economic contributor. Limited access to these resources not only exacerbates health disparities but also deprives underserved areas of essential benefits like stress relief and community bonding, both of which are crucial for enhancing overall quality of life. This paper provides one of the first detailed analyses of water-based recreation at over 61 000 inland and coastal sites across the United States. We aim to explore disparities in recreational behavior across race, ethnicity, income, and socioeconomic status. Using Advan cellphone data from more than 70 million outdoor trips, representing 215 000 census block groups, we find that communities of color, rural areas, and socioeconomically disadvantaged groups are significantly underrepresented in water-based recreational visits. Despite living similar distances from recreational sites, these groups show notably different patterns in travel distance for water-based recreation. Additionally, we find Native Americans from underserved areas have to travel 3–5 times longer distances than other groups for water-based recreation. Our findings show that the extensive and frequent cellphone mobility data could reveal policy-relevant patterns especially those made by underserved Americans often overlooked in traditional household surveys.

Ultrasound-guided Genicular Nerve Block in Patients Undergoing Knee Arthroscopy: A Randomized Controlled Trial

This study was to investigate the efficacy of ultrasound-guided genicular nerve block for patients who underwent knee arthroscopy. Patients were randomized into two groups: 1. nerve block group: ultrasound-guided genicular nerve block (superomedial, superolateral and inferomedial genicular nerve, 2-ml 0.5% ropivacaine each nerve.) prior to the general anesthesia, 2. control group: no intervention prior to the general anesthesia. The measurements were pain severity at 3,6, 12, 24, 48, and 72 hours after surgery at rest and at activity(Pain severity was primary outcome at 3 hours after surgery at rest); the time for first ambulation; straight leg raise; mechanical pain threshold of the block areas; time of the surgery, anesthesia and extubation; the use of analgesics in the perioperative period and 72 hours after the surgery; the number of patients awakening from pain on the first two nights after the surgery; the length of hospital stay; postoperative adverse effects. The pain severity was performed by VAS (A 10-point visual analogue scale, 0 points painless, 10 points severe pain) and median (interquartile range; IQR). A total of 70 patients (median age: 53 y, 32 men; 35 per group) were included. Compared to the control group, the nerve block group had a lower pain VAS score at rest (2[2-2] vs. 3[2-4], P&lt;0.01) at 3 hours, and lower pain VAS score at rest persisted for 24 hours and activity persisted for 12 hours after the surgery, also had lower intraoperative dosage of sufentanil (20±4.8 vs. 28.5±5.1 mg; P&lt;0.001), lower requirement for analgesics for pain and lower PONV (postoperative nausea and vomiting) throughout the 72-hour observation period. There were no significant difference for the incidence of postoperative adverse effects and straight leg raise. In conclusion, ultrasound-guided genicular nerve block could reduce the pain severity after knee arthroscopy and decrease the use of intraoperative sufentanil without affecting motor function.

Diblock Copolymers of Poly(ethylene oxide)-b-poly(propylene oxide) Stabilize a Blood-Brain Barrier Model under Oxidative Stress.

The blood-brain barrier (BBB) is a highly restrictive barrier at the interface between the brain and the vascular system. Even under BBB dysfunction, it is extremely difficult to deliver therapies across the barrier, limiting the options for treatment of neurological injuries and disorders. To circumvent these challenges, there is interest in developing therapies that directly engage with the damaged BBB to restore its function. Previous studies revealed that poloxamer 188 (P188), a water-soluble triblock copolymer of poly(ethylene oxide) (PEO) and poly(propylene oxide) (PPO), partially mitigated BBB dysfunction in vivo. In the context of stabilization of the damaged BBB, the mechanism of action of PEO-PPO block copolymers is unknown, and there has been minimal exploration of polymers beyond P188. In this study, a human-based in vitro BBB model under oxidative stress was used to investigate polymer-BBB interactions since oxidative stress is closely linked with BBB dysfunction in many neurological injuries and disorders. PEO-PPO block copolymers of varied numbers of chemically distinct blocks, PEO block length, and functionality of the end group of the PPO block were assessed for their efficacy in improving key physiological readouts associated with BBB dysfunction. While treatment with P188 did not mitigate damage in the in vitro BBB model, treatment with three diblock copolymers improved barrier integrity under oxidative stress to a similar extent. Of the considered variations in the block copolymer design, the reduction in the number of chemically distinct blocks had the strongest influence on therapeutic function. The demonstrated efficacy of three alternative PEO-PPO diblock copolymers in this work reveals the potential of these polymers as a class of therapeutics that directly treat the damaged BBB, expanding the options for treatment of neurological injuries and disorders.

Equitable stormwater utility fees: an integrated analysis of environmental, socioeconomic and infrastructure factors at the community scale

Abstract Municipalities worldwide implement stormwater management programs to mitigate the hydrological and water quality impacts of stormwater runoff. Stormwater utility fees (SWUF) are often used to fund such important programs by collecting revenue from residential and commercial properties. However, existing SWUFs often solely rely on the estimate of impervious surfaces and do not consider other environmental, infrastructure, and socioeconomic factors in the generation and effects of stormwater runoff. This study is the first attempt to propose a reconstruction of SWUFs from the perspectives of social equity and environmental justice. The method aims to address disparities in fee rates among residential parcels, focusing on helping economically disadvantaged communities. It integrates drainage service, potential contribution to non-point source pollution, and socioeconomic status through two alternative schemes. The two schemes allocate fees based on combined rankings of the three factors at the level of census block groups. The proposed method was applied to 88 180 residential parcels in Corpus Christi, Texas, a mid-sized coastal community. The results suggest that over 70% of the disadvantaged communities would benefit from the reconstructed SWUFs without affecting the targeted funding for stormwater infrastructure. This method builds on publicly available datasets and offers an adaptive framework for other municipalities to incorporate additional factors or datasets, representing an exploratory step toward achieving more equitable stormwater management practices.

Provenance of the Mesoproterozoic Shennongjia Group in the north Yangtze Block, South China, and implications for reconstructions of the Nuna and Rodinia supercontinents

Magmatic activity in the range ca. 1.6−1.5 Ga is spatially restricted globally, and its distribution has been an important tool for constraining the reconstruction of the Nuna supercontinent. Abundant ca. 1.6 Ga detrital zircons have recently been discovered in the Luanshigou and Taizi formations of the middle Mesoproterozoic Shennongjia Group in the north Yangtze Block, South China. Detrital zircon age spectra and multi-dimensional scaling results indicate the Shennongjia Group was derived from variable sources. The ca. 1.6 Ga detrital zircons in the middle Mesoproterozoic units were probably sourced from Laurentia and Australia-Mawson, whereas detrital zircons of other age groups were provided by the local rock units in the north Yangtze Block. Similarities in sedimentary sequences, detrital zircon age spectra, and corresponding Hf isotopic patterns of the Shennongjia Group with other Mesoproterozoic successions in Yangtze Block (e.g., Baoban-Shilu, Huili, and Kunyang groups) suggest that the block contained a number of micro-blocks during the Mesoproterozoic. Furthermore, the compiled new and published detrital zircon data from the north Yangtze Block along with those from other continents containing ca. 1.6 Ga zircons reveal that the Yangtze Block was most likely situated within a rift zone between southeast Australia-Mawson and southwest Laurentia. The ca. 1.6 Ga zircons in the Shennongjia Group were derived from these bounding source regions during the middle Mesoproterozoic. By the late Mesoproterozoic, based on a comprehensive provenance analyses and comparison of detrital zircon data, the Yangtze Block was probably located on the margins of the Rodinia supercontinent, close to north-central India, Australia, and East Antarctica.

Access to National Cancer Institute-Designated Cancer Centers Among Native American Cancer Patients

Introduction/Purpose Native Americans (NAs) are subject to high cancer mortality rates in the USA. Despite that, they face significant geographic barriers to access to cancer care. This study aims to estimate the travel distance to a National Cancer Institute (NCI)-designated cancer center for NA patients in Utah and the continental USA. Methods This IRB-approved study utilized retrospective data on genitourinary cancer patients from both NAs and white populations from February 2013 to January 2023. The distance of their geographical location to the Huntsman Cancer Institute (HCI) at the University of Utah was calculated using their home zip code and a GeoData ZIP Code Distance Calculations Matrix Template. A shapefile containing NCI-designated cancer centers was used alongside the Area Deprivation Index (ADI), matched to block groups from the 2020 census, to serve as a national control group. All geographic data was visualized in ArcGIS 10.7 by using the coordinates and a 5-digit zip code tabulation area to map locations. Results A total of 468 NA patients were eligible and included. The median travel distance for NA patients vs. white patients to HCI was 190.6 miles (range: 1.1-596.4 miles) vs. 21.6 miles (range: 1.1-269 miles, p&lt;0.0001). In the continental US, the median travel distance from NA reservations vs. ADI-matched block groups to the nearest NCI-designated cancer centers was 186.5 miles (range 77.8-629 miles) vs. 159 miles (range 1.9-671.3 miles, p&lt;0.01). Conclusion The travel distance to NCI-designated cancer center for NA cancer patients in Utah was around nine times longer than that of white cancer patients. This study highlights the significant disparity in cancer care accessibility faced by NA communities.

Neighborhood Socioeconomic Disadvantage and Acute Care Utilization in Washington State Medicaid: A Retrospective Cohort Study.

Neighborhood disadvantage has been associated with potentially preventable acute care utilization among Medicare beneficiaries, but this association has not been studied in a Medicaid population, which is important for informing more equitable care and policies for this population. To describe the association between Area Deprivation Index (ADI) and acute care utilization (including potentially preventable utilization) among Medicaid beneficiaries in Washington State. Retrospective cohort study of 100% Medicaid claims. Mixed effects logistic regression was applied to estimate the association between state-level ADI decile and acute care utilization, adjusting for age, sex, self-identified race and ethnicity, Charlson Comorbidity Index, primary spoken language, individual Federal Poverty Level, homelessness, and rurality. Standard errors were clustered at the Census block group level. 1.5 million unique adult Medicaid beneficiaries enrolled for at least 11months of a calendar year during the period 2017-2021. Binary measures denoting receipt of ED visits, low-acuity ED visits, hospitalizations in a calendar year. Increasing levels of neighborhood socioeconomic disadvantage (by ADI decile) were associated with greater odds of any ED visits (adjusted odds ratio (aOR) 1.07, 95% confidence interval (CI) 1.06-1.07), low-acuity ED visits (aOR 1.08, CI 1.08-1.08), and any hospitalizations (aOR 1.02, CI 1.02-1.02). Among Medicaid beneficiaries, greater neighborhood socioeconomic disadvantage was associated with increased acute care utilization, including potentially preventable utilization. These findings signal potential barriers to outpatient care access that could be amenable to future intervention by health systems and payers.

Template-Independent Enzymatic RNA Synthesis.

A route to prepare ribonucleoside triphosphates featuring a 3'-aminoxy (3'-O-NH 2 ) removable blocking group is reported here. We then show that versions of two DNA polymerases, human DNA polymerase theta (Polθ) and mimiviral PrimPol, accept these triphosphates as substrates to add single nucleotides to an RNA primer under engineered conditions. Cleaving the O-N bond in the 3'-O-NH 2 group within the extended primer regenerates the 3'-OH group, facilitating subsequent polymerase cycles that add a second, selected, nucleotide. These enzymes and triphosphates together enable template-independent enzymatic RNA synthesis (TIERS) exploiting a cyclic reversible termination framework. The study shows that this process is ready for instrument adaptation by using it to add three ribonucleotides in three cycles using an engineered Polθ. This work creates a new way to synthesize RNA with a de novo defined sequence, without requiring the protecting groups, hazardous solvents, and sensitive reagents that bedevil phosphoramidite-based RNA synthesis.

Supra-inguinal fascia iliaca block versus peri-capsular nerve group (PNEG) block for pain management in patients with hip fracture: A double-blind randomised comparative trial

BackgroundRegional analgesia has been recommended to alleviate pain caused by hip fractures. Both the supra-inguinal fascia iliaca block (S-FIB) and the peri‑capsular nerve group (PENG) block provide better analgesia than conventional fascia iliaca block for patients with hip fractures, but which one is superior remains equivocal. This study aimed to determine the superiority of S-FIB or PENG block for patients awaiting hip surgery. MethodsIn this prospective, double-blind, randomised comparative trial, patients with hip fractures awaiting operation were randomly allocated to receive either S-FIB with 30 ml 0.35 % ropivacaine or PENG block with 20 ml 0.35 % ropivacaine. Primary outcomes were pain scores (numeric rating scale, NRS, 0–10) at rest and during passive movement 30 min after nerve block. Secondary outcomes included pain scores at rest and during movement 10 and 20 min after nerve block and during positioning for spinal anaesthesia, time spent for performing nerve block and spinal anaesthesia, and the quality of positioning for spinal anaesthesia. ResultsOne-hundred patients were enrolled and 91 patients completed the trial (S-FIB group n = 46, PENG group n = 45). No significant difference was noted between these two groups in the pain scores (median [interquartile range]) either at rest (0 [0–0] vs 0 [0–0], P = 0.151) or during passive movement (3 [1-6] vs 3 [2-5], P = 0.99) at 30 min after nerve block. However, within-group analysis revealed that a significant reduction in pain score at rest was noted as early as 20 min after PENG block while that was noted only at 30 min after S-FIB. In addition, less time was required to perform PENG than S-FIB the block (3.1 [2.3–3.9] vs. 4.6 [3.1–5.6] minutes, P < 0.001). ConclusionsOur result suggests that with a lower dose of local anaesthetic, a shorter procedure time and earlier analgesic effect, PENG block may be preferred to S-FIB for patients with hip fracture awaiting surgery.