Large Central Area Research Articles

Mortality Patterns of Esophageal Cancer in the United States: A 21-Year Retrospective Analysis.

Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first 5 years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. The mortality trends among adults with EC were analyzed using data from the CDC WONDER database. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joinpoint regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999 to 2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and nonmetropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared with states falling in the lower 10th percentile. Over the last 2 decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

Integrated solar system for hydrogen production using steam reforming of methane

Integrating renewable technologies has emerged as a promising option in pursuing sustainable and efficient energy solutions. The primary source of industrial hydrogen is steam methane reforming (SMR); however, this process is based on fossil fuels with massive carbon byproduct emissions. The solar thermal tower appears to be a suitable renewable source for powering SMR by providing high temperature heat to drive the process reactions. This approach aims to harness the abundance of solar energy for natural gas reforming to produce hydrogen at minimum environmental impact. This research establishes the viability of combining external central receiver concentrated solar power with SMR integrated with thermal energy storage (TES), revealing general insights into the system energy and exergy performance. The analysis of the current system is performed using the thermodynamic and thermochemical approaches to conduct a parametric study. A 543 MW central receiver is first modeled with a high-temperature molten salt as a working fluid. The SMR process model is then developed, considering both reforming and shift reactions, and solved using Engineering Equation Solver (EES). The subsystem models are validated before being integrated into the overall system model. The performance of the SMR reactor is found to affect the overall system performance considerably. The results also show that when increasing the temperature above 760 ° C, no remarkable improvement in the reforming process is observed. In contrast, the higher the temperature in the water gas shift reactor, the lower the system's performance. Moreover, the impact of wind velocity on the overall system is considered due to the large central receiver surface area. The overall system performance in terms of energy, exergy, and effectiveness is evaluated for one day of operating through charging and discharging operations. In charging mode, the overall energy and exergy efficiencies are 46.5% and 57.2%, respectively, while the overall effectiveness is 61.8%; on the discharging operation, the overall energy efficiency and effectiveness have a similar definition with a value of 82.4% and the overall exergy efficiency achieves a value of 78.7%. Additionally, the amount of hydrogen produced at a central receiver of 543 MWth capacity is about 7.3 kg/s at a 2.1 steam-to-carbon ratio. This integration mitigates a minimum of 12 kg/s of CO2 emissions that would be generated due to methane combustion.

Pseudogomphonema lukinicum sp. nov. (Bacillariophyceae), a new endophytic diatom found inside multicellular red algae from the Northwest Pacific

Abstract In our collections from the Northwest Pacific waters, we found several specimens of the red algae Lukinia dissecta and Callophyllis perestenkoae with darker spots on their thalli, which contained an unusual pennate diatom. A detailed morphological analysis based on light and scanning electron microscopy observations made it possible to describe a new species of endophytic diatom, Pseudogomphonema lukinicum sp. nov. Stonik et Skriptsova. The new species has some morphological features typical of the genus, such as the heteropolarity of the valves, the presence of pseudosepta and small apical chambers at both poles of the valves, and nonporous girdle bands. Pseudogomphonema lukinicum has been described and distinguished from the other species in the genus on the basis of a combination of morphological traits, including relatively small cell dimensions, a slightly asymmetrical valve to the transapical axis, with obtusely rounded headpole and narrower footpole, the large asymmetrical central area, and the presence of apical chambers at both poles. Pseudogomphonema lukinicum is the second representative of Pseudogomphonema known to be living endophytically. The data on the species composition of endophytic diatoms in marine macroalgae, their habitats, and host organisms reported in the literature to date are summarized.

A new approach for the numerical calculation of diffraction patterns using starshades

Context. We studied the imaging of exoplanetary systems using starshades, which are externally occulted coronagraphs in space. Aims. We provide a new method for precisely evaluating the stray light due to the star and a rapid calculation of the point spread functions in the presence of vignetting effects from the external occulter. Our study used shaped occulter configurations published in the literature, in particular, the SISTER NI2 and NW2 systems. Methods. The wavefront at the telescope aperture was computed using the classic Fresnel filtering method. The Fourier transform of the occulter was obtained with the highest possible precision using an approach initially developed for radio antennas, known as the polygonal shape factor. Results. We show that the Fresnel diffraction for a finite spatial field operates at very low frequencies only, and that it is sufficient to calculate the Fourier transforms there. Diffraction patterns computed numerically fully agree with theoretical predictions. The central parts of diffractions of petal and apodized occulters are identical over a large central area that increases in size with the number of petals. These diffraction patterns are used to compute the point spread functions. We computed the stray light for a non-point source star; this shows that starshades are not sensitive to star leakage, with a star diameter limit for a given configuration. We also computed signal-to-noise ratios for a perfect experiment limited by photon noise.

Esophageal cancer in the United States: A 21-year mortality analysis (1999-2020).

e23258 Background: Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first five years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends that are undergoing substantial transformations on a global scale, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. Methods: The mortality trends among adults with EC were analyzed using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database, where EC was presented as a contributing or the underlying cause of death. Code C15 “Malignant Neoplasms of Esophagus” in the International Classification of Disease, tenth revision (ICD-10) was used to identify the data. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joint point regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. Results: Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999-2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). CMRs also increased with advancing age and were greatest in individuals over the age of 85 years. AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and non-metropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile. Conclusions: Over the last two decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

COVID-19 Vaccination Site Accessibility, United States, December 11, 2020-March 29, 2022.

During December 11, 2020-March 29, 2022, the US government delivered ≈700 million doses of COVID-19 vaccine to vaccination sites, resulting in vaccination of ≈75% of US adults during that period. We evaluated accessibility of vaccination sites. Sites were accessible by walking within 15 minutes by 46.6% of persons, 30 minutes by 74.8%, 45 minutes by 82.8%, and 60 minutes by 86.7%. When limited to populations in counties with high social vulnerability, accessibility by walking was 55.3%, 81.1%, 86.7%, and 89.4%, respectively. By driving, lowest accessibility was 96.5% at 15 minutes. For urban/rural categories, the 15-minute walking accessibility between noncore and large central metropolitan areas ranged from 27.2% to 65.1%; driving accessibility was 79.9% to 99.5%. By 30 minutes driving accessibility for all urban/rural categories was >95.9%. Walking time variations across jurisdictions and between urban/rural areas indicate that potential gains could have been made by improving walkability or making transportation more readily available.

Examining the association of rurality with opioid-related morbidity and mortality in Georgia: A geospatial analysis

IntroductionThe US opioid epidemic continues to escalate, with overdose deaths being the most-used metric to quantify its burden. There is significant geographic variation in opioid-related outcomes. Rural areas experience unique challenges, yet many studies oversimplify rurality characterizations. Contextual factors, such as area deprivation, are also important to consider when understanding a community's need for treatment services and prevention programming. This study aims to provide a geospatial snapshot of the opioid epidemic in Georgia using several metrics of opioid-related morbidity and mortality and explore differences by rurality across counties. MethodsThis was a spatial ecologic study. Negative binominal regression was used to model the relationship of county rurality with four opioid-related outcomes – overdose mortality, emergency department visits, inpatient hospitalizations, and overdose reversals - adjusting for county-level sex, racial/ethnic, and age distributions. Area Deprivation Index was also included. ResultsThere was significant geographic variation across the state for all four opioid-related outcomes. Counts remained highest among the metro areas. For rates, counties in the top quartile of rates varied by outcome and were often rural areas. In the final models, rurality designation was largely unrelated to opioid outcomes, with the exception of medium metro areas (inversely related to hospitalizations and overdose reversals) and non-core areas (inversely related to hospitalizations), as compared to large central metro areas. Higher deprivation was significantly related to increased ED visits and hospitalizations, but not overdose mortality and reversals. ConclusionsWhen quantifying the burden of the opioid epidemic in a community, it is essential to consider multiple outcomes of morbidity and mortality. Understanding what outcomes are problematic for specific communities, in combination with their demographic and socioeconomic context, can provide insight into gaps in the treatment continuum and potential areas for intervention. Additionally, compared to demographic and socioeconomic factors, rurality may no longer be a salient predictor of the severity of the opioid epidemic in an area.

Abstract 139: Regional Disparities in Mechanical Thrombectomy Utilization for Treatment of Acute Ischemic Stroke in the United States

Background: A current national priority is to understand geographic disparities in mechanical thrombectomy (MT) provision for patients with acute ischemic stroke (AIS). We examine variation in rates of MT by geographic region and urban-rural areas to identify utilization disparities across the United States. Methods: The state-specific annual incidence of AIS in 2019 was determined using data from the Global Burden of Disease Collaborative Network. We determined the number of patients who were admitted with AIS due to thrombosis or embolism of anterior circulation arteries and those who received MT in a particular region/state based on the State Inpatient Database of NIS. The National Inpatient Sample data were used to create national weighted estimates of the size of subject populations, age at admission, length of stay, and discharge status. Results: In the United States, approximately 28,165 MT were performed in 2019, representing 4% of the AIS population. In large central metropolitan areas, the proportion of thrombectomies performed to the AIS patient population was significantly higher than the national estimate (4.34%, P < 0.001); small metropolitan areas and rural settings (micropolitan and noncore) had significantly lower proportions of MT-treated patients with 3.2% and 2.9%, respectively (P < 0.001), when compared with the national estimate. West region had significantly higher proportions of MT-treated patients with 4.3%, compared with the national estimate (P < 0.001), whereas South region had significantly lower proportions with 3.8% (P < 0.001). Conclusions: We found prominent regional disparities in the utilization rates of MT in acute ischemic stroke patients in the United States, which may have implications for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities.

A new freshwater species of Pinnularia (Bacillariophyta) from Hunan Province, China.

This study describes a new species of Pinnularia, P.hupingensissp. nov., on the basis of light and scanning electron microscope images. Pinnulariahupingensissp. nov. is characterised by its linear valve outline, extremely divergent striae, and very large hexagonal central area occupying ca. 1/5-1/8 of the valve length. The primary and secondary sides of the valve and the internal proximal raphe fissures are discussed. The new species is compared to similar taxa of the genus Pinnularia.

Individualized foveated rendering with eye-tracking head-mounted display

Foveated rendering (FR) technology is designed to improve the efficiency of graphical rendering processes. In rendering, individualized approaches can help to balance users’ experiences of visual quality and saving computational resource. However, previous studies have not rigorously examined it related with the FR techniques. To address this issue, we developed an individualized FR (IFR) method using different central vision sizes and peripheral vision resolutions across individuals in virtual reality. In three user studies with 88 participants who were divided into groups designated as “large central area (LCA)” and “small central area (SCA),” the effects of IFR were compared with those of using the full-resolution condition and the average FR condition. The results indicate that the LCA group experienced higher visual quality under the IFR and full-resolution conditions than under the average FR condition. In contrast, the SCA group exhibited comparable levels of dependent measures between the IFR and average FR conditions, but both were lower than those of the full-resolution condition. We also evaluated the computational benefits of the proposed IFR method, and the results demonstrated the effectiveness of our approach in saving resources across the two groups. Although lower-bound adjustments may be required for some users, our overall results suggest that IFR is a malleable technology for enhancing rendering efficiency in virtual reality.

The spatial mobility network and influencing factors of the higher education population in China

Abstract The scale and frequency of talent mobility in the world have increased sharply, and the competition for talent has intensified in various regions. This paper mainly studies the spatial mobility characteristics and influencing factors of China’s highly educated talents. It found that China’s higher education population mobility network has prominent uneven characteristics, the central and eastern regions of China, especially the eastern coastal regions, are the hotspots of the network. The higher education population flows frequently in large cities and regional central areas. The hierarchical structure follows a “north-south division,” which is dominated by Beijing and Shanghai, respectively. Geographical distance has a specific hindering effect in this context. Furthermore, the similarity of culture, institutions, customs, and dialect facilitates the mobility of the higher education population. Cities with high economic levels, centralized educational resources, sound infrastructure, and aesthetically appealing environments are also likely to attract more talents.

Excess deaths associated with COVID-19 by rurality and demographic factors in the United States.

To estimate percent excess deaths during the COVID-19 pandemic by rural-urban residence in the United States and to describe rural-urban disparities by age, sex, and race/ethnicity. Using US mortality data, we used overdispersed Poisson regression models to estimate monthly expected death counts by rurality of residence, age group, sex, and race/ethnicity, and compared expected death counts with observed deaths. We then summarized excess deaths over 6 6-month time periods. There were 16.9% (95% confidence interval [CI]: 16.8, 17.0) more deaths than expected between March 2020 and February 2023. The percent excess varied by rurality (large central metro: 18.2% [18.1, 18.4], large fringe metro: 15.6% [15.5, 15.8], medium metro: 18.1% [18.0, 18.3], small metro: 15.5% [15.3, 15.7], micropolitan rural: 16.3% [16.1, 16.5], and noncore rural: 15.8% [15.6, 16.1]). The percent excess deaths were 20.2% (20.1, 20.3) for males and 13.6% (13.5, 13.7) for females, and highest for Hispanic persons (49% [49.0, 49.6]), followed by non-Hispanic Black persons (28% [27.5, 27.9]) and non-Hispanic White persons (12% [11.6, 11.8]). The 6-month time periods with the highest percent excess deaths for large central metro areas were March 2020-August 2020 and September 2020-February 2021; for all other areas, these time periods were September 2020-February 2021 and September 2021-February 2022. Percent excess deaths varied by rurality, age group, sex, race/ethnicity, and time period. Monitoring excess deaths by rurality may be useful in assessing the impact of the pandemic over time, as rural-urban patterns appear to differ.

Abstract A095: Rural disparities in telemedicine use among cancer survivors during the COVID-19 pandemic

Abstract Background: The COVID-19 pandemic has led to significant changes in the delivery of healthcare across the world, including the widespread adoption of telemedicine. This study examined the prevalence of telemedicine use by rurality and determined whether rurality was associated with its use among cancer survivors in the United States (US). Methods: The 2021 National Health Interview Survey (NHIS) was used to examine the use of telemedicine among cancer survivors during the pandemic. Our primary outcome is telemedicine use and rurality is our main exposure of interest. Other covariates of interest include demographics, health-related factors (number of comorbidities, self-rated health), and types of cancer history. Descriptive statistics and multiple logistic regression models were used to examine the mentioned association. Results: Among 27,500 eligible cancer survivors, 51.6% (14,140 participants) of them reported telemedicine use. The use of telemedicine varied by rurality, with 41.4% of rural cancer survivors using telemedicine compared to 58.4% of cancer survivors in large central metropolitan areas (p<0.001). Rural cancer survivors had significantly lower odds of using telemedicine during the pandemic compared to metropolitan cancer survivors. Cancer survivors residing in rural were 0.58 times less likely (95% CI, 0.43 to 0.78) and cancer survivors residing in medium and small metropolitan areas were 0.72 times less likely (95% CI, 0.56 to 0.93) to report telemedicine use compared to cancer survivors residing in large central metropolitan areas. Conclusion: Significant rural disparities in telemedicine use were evident among cancer survivors. Rural cancer survivors were less likely to use telemedicine during the COVID-19 pandemic. To ensure equitable access to telemedicine, continued reimbursement for telemedicine services, but additional efforts are needed to improve access to and utilization of healthcare for rural cancer survivors. Citation Format: Minjee Lee, Meng-Han Tsai. Rural disparities in telemedicine use among cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A095.

Who Gets Sick From COVID-19? Sociodemographic Correlates of Severe Adult Health Outcomes During Alpha- and Delta-Variant Predominant Periods: September 2020-November 2021.

Because COVID-19 case data do not capture most SARS-CoV-2 infections, the actual risk of severe disease and death per infection is unknown. Integrating sociodemographic data into analysis can show consequential health disparities. Data were merged from September 2020 to November 2021 from 6 national surveillance systems in matched geographic areas and analyzed to estimate numbers of COVID-19-associated cases, emergency department visits, and deaths per 100 000 infections. Relative risks of outcomes per infection were compared by sociodemographic factors in a data set including 1490 counties from 50 states and the District of Columbia, covering 71% of the US population. Per infection with SARS-CoV-2, COVID-19-related morbidity and mortality were higher among non-Hispanic American Indian and Alaska Native persons, non-Hispanic Black persons, and Hispanic or Latino persons vs non-Hispanic White persons; males vs females; older people vs younger; residents in more socially vulnerable counties vs less; those in large central metro areas vs rural; and people in the South vs the Northeast. Meaningful disparities in COVID-19 morbidity and mortality per infection were associated with sociodemography and geography. Addressing these disparities could have helped prevent the loss of tens of thousands of lives.

Selective Dorsal Rhizotomy: Patient Demographics and Postoperative Physical Therapy

BackgroundSelective dorsal rhizotomy (SDR) is a surgical procedure that permanently alters lower extremity spasticity, common in children with spastic cerebral palsy (CP). Intensive postoperative physical therapy (PT) is recommended following SDR. The first purpose of this study is to describe and compare patient demographics between children who received SDR and the population of children with CP at one institution. The second purpose of this study is to compare the completed dose of postoperative PT with the clinically recommended dose for a subset of ambulatory children who underwent SDR. MethodsThis retrospective, observational study included 60 children with spastic CP following SDR. A subset (n = 12 ambulatory children) was included to describe the dose of postoperative PT. Information gathered from electronic medical records included age at the time of SDR, sex, Gross Motor Function Classification System level, anatomic distribution, race, county-level habitancy, health insurance provider, timed current procedural terminology codes, and location for postoperative PT encounters within a single institution. ResultsBlack or African American children (P = 0.002), children living in large central metro areas (P = 0.033), and children with public insurance (P ≤ 0.001) were significantly less likely to receive SDR. Children undergoing SDR do not achieve the recommended dose of PT after hospital discharge. ConclusionSDR is not equally accessed by patient populations, and postoperative PT frequency is below current recommendations throughout the rehabilitation process. Future studies need to investigate why these disparities exist and what prevents children from meeting the clinically recommended dose of postoperative PT after SDR.

Rural disparities in telemedicine use among cancer survivors during the COVID-19 pandemic.

e13686 Background: The COVID-19 pandemic has led to significant changes in the delivery of healthcare across the world, including the widespread adoption of telemedicine. This study examined the prevalence of telemedicine use by rurality and determined whether rurality was associated with its use among cancer survivors in the United States (US). Methods: The 2021 National Health Interview Survey (NHIS) was used to examine the use of telemedicine among cancer survivors during the pandemic. Our primary outcome is telemedicine use and rurality is our main exposure of interest. Other covariates of interest include demographics, health-related factors (# of comorbidities, self-rated health), and types of cancer history. Descriptive statistics and multiple logistic regression models were used to examine the mentioned association. Results: Among 27,500 eligible cancer survivors, 51.6% (14,140 participants) of them reported telemedicine use. The use of telemedicine varied by rurality, with 41.4% of rural cancer survivors using telemedicine compared to 58.4% of cancer survivors in large central metropolitan areas (p < 0.001). Rural cancer survivors had significantly lower odds of using telemedicine during the pandemic compared to metropolitan cancer survivors. Cancer survivors residing in rural were 0.58 times less likely (95% CI, 0.43 to 0.78) and cancer survivors residing in medium and small metropolitan areas were 0.72 times less likely (95% CI, 0.56 to 0.93) to report telemedicine use compared to cancer survivors residing in large central metropolitan areas. Conclusions: Significant rural disparities in telemedicine use were evident among cancer survivors. Rural cancer survivors were less likely to use telemedicine during the COVID-19 pandemic. To ensure equitable access to telemedicine, continued reimbursement for telemedicine services, but additional efforts are needed to improve access to and utilization of healthcare for rural cancer survivors.

Urban and Rural Mpox Incidence Among Persons Aged 15–64 Years — United States, May 10–December 31, 2022

During May 10-December 31, 2022, a total of 29,980 confirmed and probable† U.S. monkeypox (mpox) cases were reported to CDC, predominantly in cisgender adult men reporting recent same-gender sexual partners (1). Urban-rural differences in health (2) and diagnosis of HIV (3,4) and other sexually transmitted infections (5) are well documented nationally. This report describes urban-rural differences in mpox incidence (cases per 100,000 population) among persons aged 15-64 years, by gender and race and ethnicity. Urbanicity was assessed using the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties (2). Substantial differences in incidence by urbanicity, gender, and race and ethnicity were observed; most (71.0%) cases occurred in persons residing in large central urban areas. Among the cases in large central urban areas, most (95.7%) were in cisgender men. The overall incidence of mpox in the United States was 13.5 per 100,000 persons aged 15-64 years and peaked in August in both urban and rural areas. Among cisgender men, incidence in rural areas was approximately 4% that in large central urban areas (risk ratio [RR]=0.04). Among cisgender women, incidence in rural areas was approximately 11% that in large central urban areas (RR=0.11). In both urban and rural areas, incidence among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) persons was consistently higher than that among non-Hispanic White (White) persons; RRs between Black and White persons were highest in rural areas. Support and maintenance of mpox surveillance and prevention efforts including vaccinations should focus on urban areas with the highest incidence of mpox during the 2022 outbreak; however, surveillance and prevention efforts should include all genders, persons of color, and persons residing in both urban and rural areas who are at increased risk for mpox.

Metastasis to the sublingual gland of metaplastic breast carcinoma – a case report

Metastatic spread to the salivary glands is rare, occurring primarily from head and neck tumors to the parotid gland. So far, only one sublingual gland metastasis has been reported in the literature. We herein report the second case of metastasis to this gland occurring in a woman in her 50s, previously diagnosed with HER2-positive metaplastic breast carcinoma (MpBC) with chondroid differentiation, with lymph node and diffuse organ metastases. The sublingual lesion presented as a tumefaction on the floor of the mouth, causing masticatory discomfort. Histologically it was formed by epithelial cells with high-grade cytomorphological features with a large central area of chondroid differentiation. The case was clinically and pathologically challenging, given the rarity of the primary MpBC and the improbable secondary location. Alternative primary salivary gland tumors with chondroid differentiation were considered, but ultimately the clinical integration was crucial in establishing the diagnosis of MpBC metastasis to the sublingual gland.

Study of terrestrial diatoms in corticolous assemblages from deciduous trees in Central Europe with descriptions of two new Luticola D.G.Mann taxa.

Although many studies have examined the algae associated with various habitats in tree trunks, the diatoms in these environments are still poorly studied. Studies of corticolous algae mainly focus on green algae and cyanobacteria, which are usually immediately visible, while diatoms are mostly overlooked or not reported. During the research, 143 species of diatoms were identified, including two new representatives of the genus Luticola: L.bryophilasp. nov. with relatively large central area and short distal raphe endings and L.confusasp. nov. characterized by the presence of small depressions on central raphe endings. Both are described herein based on light and scanning electron microscopy observations and compared to similar taxa based on literature data. Basic morphological data for almost all the diatom taxa are noted, and their habitat requirements, and photographic documentation are also presented. The present research showed that the occurrence of diatom assemblages on tree trunks is influenced by various factors like host tree species, the area where the host tree grows, and the availability of suitable microhabitats within the trunk. However, the species composition of this assemblages depends mainly on the tree species.

Glyphosate exposure in early pregnancy and reduced fetal growth: a prospective observational study of high-risk pregnancies

BackgroundPrenatal glyphosate (GLY) exposure is associated with adverse reproductive outcomes in animal studies. Little is known about the effects of GLY exposure during pregnancy in the human population. This study aims to establish baseline urine GLY levels in a high-risk and racially diverse pregnancy cohort and to assess the relationship between prenatal GLY exposure and fetal development and birth outcomes.MethodsRandom first trimester urine specimens were collected from high risk pregnant women between 2013 and 2016 as part of the Indiana Pregnancy Environmental Exposures Study (PEES). Demographic and clinical data were abstracted from mother and infant medical records. Urine glyphosate levels were measured as a proxy for GLY exposure and quantified using liquid chromatography-tandem mass spectrometry. Primary outcome variables included gestation-adjusted birth weight percentile (BWT%ile) and neonatal intensive care unit (NICU) admission. Relationships between primary outcome variables and GLY exposure were assessed using univariate and multivariate linear and logistic regression models.ResultsUrine GLY levels above the limit of detection (0.1 ng/mL) were found in 186 of 187 (99%) pregnant women. Further analyses were limited to 155 pregnant women with singleton live births. The mean age of participants was 29 years, and the majority were non-Hispanic white (70%) or non-Hispanic Black (21%). The mean (± SD) urine GLY level was 3.33 ± 1.67 ng/mL. Newborn BWT%iles were negatively related to GLY (adjusted slope ± SE = -0.032 + 0.014, p = 0.023). Infants born to women living outside of Indiana’s large central metropolitan area were more likely to have a lower BWT%ile associated with mother’s first trimester GLY levels (slope ± SE = -0.064 ± 0.024, p = 0.007). The adjusted odds ratio for NICU admission and maternal GLY levels was 1.16 (95% CI: 0.90, 1.67, p = 0.233).ConclusionGLY was found in 99% of pregnant women in this Midwestern cohort. Higher maternal GLY levels in the first trimester were associated with lower BWT%iles and higher NICU admission risk. The results warrant further investigation on the effects of GLY exposure in human pregnancies in larger population studies.