Nonadjacent Areas Research Articles

Non-surgical treatment for tandem spinal stenosis: a systematic review protocol

BackgroundTandem Spinal Stenosis (TSS) is a disease characterised by the narrowing of the spinal canal in two or more non-adjacent areas of the spine, often affecting both the cervical and lumbar vertebrae. Doctors and patients increasingly favour non-surgical treatments that have the function of relieving symptoms and improving outcomes. This systematic review aims to evaluate the effectiveness and safety of non-surgical therapies for TSS and comprehensively summarise existing evidence.Methods and analysisWe will conduct comprehensive searches, both manual and electronic, of literature published up to 30 September 2024; database searches will commence after the publication of this agreement, with an estimated commencement date of 1 December 2024, and the end date is 31 May 2025, without language restrictions. Key databases such as MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Library, WHO International Clinical Trial Registration Platform, China National Knowledge Infrastructure, China Biomedical Literature Database, China Scientific Journal Database and Wan-Fang Database will be explored. In addition, we will include resources such as library journals and conference abstracts. Following the identification and screening of all randomised controlled trials focusing on non-surgical treatments for TSS, two investigators will perform a meta-analysis of the included studies. The findings will be summarised as the risk ratio for binary data and the standardised or weighted mean difference for continuous data.Ethics and disseminationEthical approval is not required, as the review does not involve individual patient data. The review’s findings will provide clinicians with evidence on using non-surgical treatments for TSS, disseminated through peer-reviewed publications or conferences.PROSPERO registration numberCRD42024496634.

Machine learning-based estimation of evapotranspiration under adaptation conditions: a case study in Heilongjiang Province, China.

The prediction of evapotranspiration (ET0) is crucial for agricultural ecosystems, irrigation management, and environmental climate regulation. Traditional methods for predicting ET0 require a variety of meteorological parameters. However, obtaining data for these multiple parameters can be challenging, leading to inaccuracies or inability to predict ET0 using traditional methods. This affects decision-making in critical applications such as agricultural irrigation scheduling and water management, consequently impacting the development of agricultural ecosystems. This issue is particularly pronounced in economically underdeveloped regions. Therefore, this paper proposes a machine learning-based evapotranspiration estimation method adapted to evapotranspiration conditions. Compared to traditional methods, our approach relies less on the variety of meteorological parameters and yields higher prediction accuracy. Additionally, we introduce a 'region of evapotranspiration adaptability' division method, which takes into account geographical differences in ET0 prediction. This effectively mitigates the negative impact of anomalies or missing data from individual meteorological stations, making our method more suitable for practical agricultural irrigation and ecosystem water resource management. We validated our approach using meteorological data from 25 stations in Heilongjiang, China. Our results indicate that non-adjacent geographical areas, despite different climatic conditions, can have similar impacts on ET0 prediction. In summary, our method facilitates accurate ET0 prediction, offering new insights for the development of agricultural irrigation and ecosystems, and further contributes to agricultural food supply.

The role of noncontiguous attendance zones in shaping school populations: A case study of Tucson, Arizona and Fort Bend, Texas

Noncontiguous school attendance zone boundaries (AZBs) have a unique, relatively uncommon shape that assign two or more non-adjacent residential areas to the same school. Given their ability to shape school enrollments by taking advantage of residential sorting, noncontiguous AZBs have historically been linked to explicit efforts to both segregate and desegregate schools. In this paper, we use a novel, longitudinal dataset of AZBs and descriptive quantitative and geospatial methods to understand how the relationship between noncontiguous zones, school diversity, and neighborhood demographics changed from 1990-2020 in two southwestern school districts—Tucson Unified School District, Arizona and Fort Bend Independent School District, Texas. Each district has a unique legal history and demographic context that informs their use of noncontiguous AZBs. We find noncontiguous AZBs are more strongly associated with racially diverse schools and are more likely to bring together neighborhoods with different compositions in Tucson compared to Fort Bend. However, the association between Tucson’s noncontiguous AZBs and racially diverse schools has waned since 1990, as the district has negotiated the end of its court-ordered desegregation plan. Our findings provide insight into when and how noncontiguous AZBs can effectively contribute to ethnoracially diverse schools.

The importance of brain mapping for rehabilitation in birth nonprogressive neuromuscular diseases.

While motor mapping has been extensively studied in acquired motor conditions, a lack has been observed in terms of research on neurological disorders present since birth, with damage to the spinal cord and peripheral nerves (hence, defined in this study as nonprogressive neuromuscular diseases). Despite an injury at the level below the brain, the subsequent changes in the motor system involve cortical reorganization. In the scientific community, the need for a comprehensive approach targeting the brain is increasingly recognized for greater motor recovery in these patients. Transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) are the most utilized techniques for motor mapping. The knowledge obtained through motor mapping may be used to develop effective individual neuromodulation therapy that helps in functional motor recovery. This brief review compares the results of the brain mapping of a few existing studies in individuals with nonprogressive motor disorders of nonbrain origin present at birth to the brain mapping of individuals with similar acquired motor conditions. The review reveals some particular features in terms of central adaptation in individuals with birth conditions compared to their acquired counterparts, such as the nonsomatotopic presentation of involved muscles in the sensorimotor cortex and nonadjacent cortical areas. This topic is undoubtedly intriguing, justifying further research in the field. This review also discusses the benefits these patients can obtain from neuromodulation therapy addressed to the central nervous system and the importance of individual neurophysiological assessment in designing rehabilitation therapy for children with birth motor disorders.

Investigation into the Performance Characteristics of the Organic Dry Farming Transition and the Corresponding Impact on Carbon Emissions Reduction

Global warming affects food security and ecological security, and it threatens economic stability and sustainable agricultural development. The transformation and development of agriculture have significant implications for the achievement of the “dual-carbon” goals and the promotion of sustainable agricultural development. Based on panel data on organic dry farming in China from 2005 to 2020, this study aimed to comprehensively assess the transformation performance of organic dry farming (TRODF) in 15 provinces. It explored the impact of the transformation of organic dry farming on carbon emissions by utilizing a spatial Markov chain and spatial measurement models. Our findings are as follows: (1) The performance of the organic dryland agriculture transformation has gradually improved and is accompanied by a corresponding trend of fluctuating regional disparities, which are on the rise. Moreover, the disparities between the five major regions mainly stem from intra-regional differences. (2) TRODF agriculture presents the possibility of state transfer during different periods, featuring four convergent zones: a lagging zone, a starting zone, a crossing zone, and an advanced zone. The spatial Markov chain indicates that state transitions typically occur between adjacent levels, with fewer instances of “jump”-type transitions. Moreover, there is a clear trend of differentiation in the state transitions between non-adjacent areas. (3) The organic dry farming transformation exhibits a significant carbon reduction effect, which is characterized by heterogeneity across different stages of agricultural development, provinces, and time periods. This study emphasizes that economic and industrial transformation, along with the transformation of the ecological environment, represents a crucial direction for conserving resources and achieving a further reduction in carbon emissions.

Differences in cancer presentation, treatment, and mortality between rural and urban patients diagnosed with kidney cancer in the United States

IntroductionRural–urban discrepancies in care and outcomes for kidney cancer (KCa) in the United States remains poorly understood. Our study aims to improve our understanding of the influence of rurality on KCa outcomes in the United States by analyzing differences in presentation, treatment, and mortality between urban areas (UAs) and rural areas (RAs) in the Surveillance, Epidemiology, and End Results (SEERs) database. MethodsSEERs data was queried from 2000 to 2019 for KCa patients. Patient counties were classified as UAs, rural adjacent areas (RAAs), or rural nonadjacent areas (RNAs) using Rural Urban Continuum Codes. Demographic, tumor characteristics, and treatment variables were compared. Propensity score matching was performed to create matched UA-RAA and UA-RNA cohorts. Multivariate regression evaluated rural-urban status as a predictor of treatment selection. Multivariate cox regression assessed the predictive value of rural-urban status for overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier analysis was used to generate survival curves for OS and CSS. Results179,509 KCa patients were identified (UA = 87.0%, RAA = 7.7%, RNA = 5.3%). Patients in RAs were more likely to present with tumors of higher grade and stage than UAs. Following multivariate analysis, rural residency predicted undergoing nephrectomy (RAA: OR = 1.177, RNA: OR = 1.210) but was a negative predictor of receiving partial nephrectomy (RAA: OR = 0.744, RNA: OR = 0.717), all P < 0.001. Multivariate cox regression demonstrated that RAA or RNA residency was predictive of overall and cause-specific mortality. After matching, median OS was 151, 124, and 118 months for UA, RAA, and RNA cohorts respectively; mean CSS was 152, 147, and 144 months for UA, RAA, and RNA cohorts, respectively, all P < 0.001. Stage-specific analysis of CSS demonstrated significantly poorer CSS among RNA patients for localized, regionalized, and distant KCa after matching. Only RAA patients with localized KCa experienced significantly lower CSS than UA patients. ConclusionsPatients in RAs are more likely to present with advanced KCa at diagnosis compared to those in UAs and may also experience different treatment options including a lesser likelihood of undergoing partial nephrectomy. Rural patients with KCa also demonstrated significantly worse OS and CSS compared to their urban counterparts. Further patient-level studies are required to better understand the discrepancy in CSS between urban and rural patients diagnosed with KCa.

The Regulating Effect of Urban Large Planar Water Bodies on Residential Heat Islands: A Case Study of Meijiang Lake in Tianjin

Efficiently harnessing the urban cool island effect associated with large urban aquatic bodies holds significant importance in mitigating the urban heat island (UHI) effect and enhancing the quality of residential living. This study focuses on Tianjin’s Meijiang Lake and its surrounding 47 residential areas, combining Landsat 8 remote sensing satellite data with geographic information system (GIS) buffer analyses and multiple linear regression analyses to reveal the summer thermal characteristics of residential waterfront areas with diverse spatial layouts. The results indicate that: (1) Meijiang Lake’s effective cooling radius extends up to 130 m from the water’s edge, achieving a maximum temperature reduction of 14.44%. Beyond 810 m, the cooling effect diminishes significantly. (2) Waterfront distance (WD), building density (BD), building width (L) and normalized difference vegetation index (NDVI) emerge as the primary factors influencing changes in average land surface temperature (ΔLST) in residential areas. The degrees of influence are ordered as follows: BD &gt; WD &gt; NDVI &gt; L. “Dispersed” pattern residential areas exhibit the most favorable thermal environments, which are primarily influenced by WD, while “parallel” pattern residential areas demonstrate the least favorable conditions, primarily due to WD and NDVI. (3) The direct adjacency of residential areas to large-scale aquatic bodies proves to be the most effective approach for temperature reduction, resulting in a 5.03% lower average temperature compared to non-adjacent areas. Consequently, this study derives strategies for improving the thermal environment via the regulation of spatial planning elements in residential areas, including waterfront patterns, vegetation coverage, WD, and BD.

Dynamics and calculation of the basic reproduction number for a nonlocal dispersal epidemic model with air pollution.

In order to reflect the dispersal of pollutants in non-adjacent areas and the large-scale movement of individuals, this paper proposes an epidemic model of nonlocal dispersal with air pollution, where the transmission rate is related to the concentration of pollutants. This paper checks the uniqueness and existence of the global positive solution and defines the basic reproduction number, . We simultaneously explore the global dynamics: when , the disease-free stable point is global asymptotic stability; when , the disease is uniformly persistent. Additionally, in order to approximate , a numerical method has been introduced. Illustrative examples are used to verify the theoretical outcomes and show the effect of the dispersal rate on the basic reproduction number .

A study of the effects and mechanisms of the digital economy on high-quality tourism development: evidence from the Yangtze River Delta in China

ABSTRACT This paper discussed the spatial effects and influence mechanisms of the digital economy on high-quality tourism development in the Yangtze River Delta. It is found that the digital economy promoted high-quality tourism development with a spatial diffusion effect. The digital economy of cities in metropolitan and adjacent area contributed to high-quality tourism development. In non-metropolitan and non-adjacent areas, the lack of core city leadership and support of metropolitan policy are important factors that hinder the functioning of digital economy. Mediation effect model shows that the digital economy could drive high-quality tourism development by improving government efficiency and expanding market potential.

Featured Collection Introduction: Severe Sustained Drought Revisited: Managing the Colorado River System in Times of Water Shortage 25 Years Later — Part I

Featured Collection Introduction: Severe Sustained Drought Revisited: Managing the Colorado River System in Times of Water Shortage 25 Years Later — Part I

68Ga-DOTATATE PET-Based Radiation Contouring Creates More Precise Radiation Volumes for Patients With Meningioma

Radiation treatment planning for meningiomas traditionally involves magnetic resonance imaging (MRI) contrast enhanced images to define residual tumor. However, the gross tumor volume may be difficult to delineate for patients with a meningioma in the skull base sagittal sinus or after resection. Advanced positron emission tomography (PET) imaging using 68Ga-DOTATATE, which has been shown to be more sensitive and specific than MRI imaging, can be used for target volume delineation in these circumstances. We hypothesized that 68Ga-DOTATATE PET scan-based treatment planning would lead to smaller radiation volumes and would detect additional areas of disease compared with standard MRI alone. Our data evaluated retrospective, deidentified, and blinded gross tumor volume contour delineation with 7 central nervous system (CNS) specialists (4 CNS radiation oncologists and 3 neuroradiologists) for 25 patients with a meningioma diagnosis who received both a 68Ga-DOTATATE PET and an MRI for radiation treatment planning. Both the MRI and the PET were nonsequentially contoured by each physician for each patient. The median MRI volume for each physician ranged from 16.94-25.53 cm3. The median PET volume for each physician ranged from 2.09 to 8.36 cm3. The median PET volume was smaller for each physician. In addition, 7 of the 25 patients (28%) hadnew nonadjacent areas contoured on PET by at least 6 of the 7 physicians that were not contoured by these physicians on the corresponding MRI. These new areas would not have been in the traditional MRI-based volumes. Our study supports that 68Ga-DOTATATE PET imaging may help radiation oncologists create more precise radiation treatment volumes through finding undetected areas of disease not seen on MRI. Treatment planning guided by 68Ga-DOTATATE PET should be studied prospectively.

NIMG-62. 68(GA)DOTATATE PET-BASED RADIATION CONTOURING CREATES SMALLER AND MORE PRECISE RADIATION VOLUMES FOR MENINGIOMA PATIENTS

Abstract PURPOSE Radiation treatment planning for meningiomas conventionally involves MRI contrast enhanced images to define residual tumor. However, the gross tumor volume may be difficult to delineate for patients with a meningioma in the skull base, sagittal sinus, or post resection. Advanced PET imaging using 68(GA)DOTATATE PET, which has been shown to be more sensitive and specific than MRI imaging, can be used for target volume delineation in these circumstances. We hypothesize that 68(GA)DOTATATE PET scan-based treatment planning will lead to smaller radiation volumes and will detect additional areas of disease compared to standard MRI alone. METHODS Our data evaluated retrospective, deidentified, and blinded gross tumor volume (GTV) contour delineation with 7 CNS specialists (3 neuroradiologists, 4 CNS radiation oncologists) for 26 patients diagnosed with a meningioma who received both a 68(GA)DOTATATE PET and an MRI for radiation treatment planning. Both the MRI and the PET were non-sequentially contoured by each physician for each patient. RESULTS The mean MRI volume for each physician ranged from 24.14-35.52 ccs. The mean PET volume for each physician ranged from 10.59-20.54 ccs. The PET volumes were significantly smaller for 6 out of the 7 physicians. In addition, 7/26 (27%) patients had new non-adjacent areas contoured on PET by at least 6 of the 7 physicians that were not contoured by these physicians on the corresponding MRI. These new areas would not have been in the traditional MRI based volumes. CONCLUSION Our study supports that 68(GA)DOTATATE PET imaging can help radiation oncologist create smaller and more precise radiation treatment volumes. Utilization of 68(GA)DOTATATE PET may find undetected areas of disease which in turn can improve local control and progression free survival. 68(GA)DOTATATE PET guided treatment planning should be studied prospectively.

68(GA)DOTATATE PET-Based Radiation Volumes Demonstrate Increased Precision Compared to MRI Based Volumes for Meningioma Patients

<h3>Purpose/Objective(s)</h3> Radiation treatment planning for meningioma conventionally involves MRI contrast enhanced images to define residual tumor. However, the gross tumor volume may be difficult to delineate for patients with a meningioma in the skull base, sagittal sinus, or post resection. Advanced PET imaging using 68(GA)DOTATATE PET, which has been shown to be more sensitive and specific than MRI imaging, can be used for target volume delineation in these circumstances. We hypothesize that 68(GA)DOTATATE PET scan-based treatment planning will lead to differences in radiation treatment volumes and will be more precise compared to standard MRI alone. <h3>Materials/Methods</h3> Our study evaluated retrospective, deidentified, and blinded gross tumor volume (GTV) contour delineation of 5 CNS specialists (3 neuroradiologists, 2 CNS radiation oncologists) for 26 patients diagnosed with a meningioma who received both a 68(GA)DOTATATE PET and an MRI for radiation treatment planning. Both the MRI and the PET-based GTV were non-sequentially contoured by each physician for each patient. We defined a significant difference in volume delineation if there was > 100% difference in contoured volume found for 80% of physicians or more when comparing MRI and PET. A PET only lesion was defined as any lesion not seen on MRI but delineated on PET imaging by at least 80% of physicians. This lesion would need to be non-adjacent to the MRI based contours for the same patient. <h3>Results</h3> The mean volume of MRI based contours was 12.5 ccs (range 0.55-62 ccs). The mean volume for PET directed contours was 13.7 ccs (range 0.24-94 ccs). We found 15/26 (58%) patients had at least a 100% difference in volume between PET and MRI for 80% of physician contours. 8/26 (31%) patients had new non-adjacent areas contoured on PET that were not contoured by these physicians on the corresponding MRI. These new areas would not have been in the traditional MRI based volumes. <h3>Conclusion</h3> We found a significant difference in PET based volumes with 58% showing major differences in volume and 31% showing new areas not seen on MRI. This has major implications on tumor control. Our study supports that 68(GA)DOTATATE PET imaging can help radiation oncologist be more precise with radiation treatment volumes. Utilization of 68(GA)DOTATATE PET may find undetected areas of disease which in turn can improve local control and progression free survival. 68(GA)DOTATATE PET guided treatment planning should be studied prospectively.

A description and summary of the Antarctic Humpback Whale Catalogue

The Antarctic Humpback Whale Catalogue (AHWC) is an international collaborative project investigating movement patterns of humpback whales in the Southern Ocean and corresponding lower latitude waters. The collection contains records contributed by 261 researchers and opportunistic sources. Photographs come from all of the Antarctic management areas, the feeding grounds in southern Chile and also most of the known or suspected low-latitude breeding areas and span more than two decades. This allows comparisons to be made over all of the major regions used by Southern Hemisphere humpback whales. The fluke, left dorsal fin/flank and right dorsal fin/flank collections represent 3,655, 413 and 407 individual whales respectively. There were 194 individuals resighted in more than one year, and 82 individuals resighted in more than one region. Resightings document movement along the western coast of South America and movement between the Antarctic Peninsula and western coast of South America and Central America. A single individual from Brazil was resighted off South Georgia, representing the first documented link between the Brazilian breeding ground and any feeding area. A second individual from Brazil was resighted off Madagascar, documenting long distance movement of a female between non-adjacent breeding areas. Resightings also include two matches between American Samoa and the Antarctic Peninsula, documenting the first known feeding site for American Somoa and setting a new long distance seasonal migration record. Three matches between Sector V and eastern Australia support earlier evidence provided by Discovery tags. Multiple resightings of individuals in the Antarctic Peninsula during more than one season indicate that humpback whales in this area show some degree of regional feeding area fidelity. The AHWC provides a powerful non-lethal and non-invasive tool for investigating the movements and population structure of the whales utilising the Southern Ocean Sanctuary. Through this methodical, coordinated comparison and maintenance of collections from across the hemisphere, large-scale movement patterns may be examined, both within the Antarctic, and from the Antarctic to breeding grounds at low latitudes.

A never-ending story of the common shrew: searching for the origin.

A range-wide phylogeographic study of the common shrew Sorex araneus was performed using the concatenation of cytb and ND2 mitochondrial genes. The data support two major lineages, one of which (European haplogroup) is distributed continuously from West Europe to West Siberia; the other (Siberian haplogroup) is found in two non-adjacent areas: in central Siberia and in southern Finland and Karelia. Several smaller subclades (East European, Balkan, and West Siberian) were identified within the European lineage. Ancestral area reconstructions were performed under the maximum parsimony criterion using the algorithm that was designed to analyze landmark data. The results suggest that the last common ancestor of the common shrew inhabited the Balkans or the Danubian-Carpathian area. The results of demographic analyses are consistent with the hypothesis of recent expansion throughout the entire distribution range. The genetic diversity indices and the expansion time estimates were higher in the western part of the range. Cumulatively, these findings support the hypothesis that during the Last Glacial Maximum, the range of the common shrew was restricted to a single refugium in Southeastern Europe.

Regulatory T cells and IgE expression in duodenal mucosa of Strongyloides stercoralis and human T lymphotropic virus type 1 co-infected patients.

BackgroundStrongyloides stercoralis is an intestinal nematode unique in its ability to replicate in the human host, allowing ongoing cycles of autoinfection, persisting for decades within the same host. Although usually asymptomatic, overwhelming infections can occur in Strongyloides and HTLV-1 co-infected individuals (SS/HTLV-1). Regulatory T cells (Tregs) are able to blunt specific Th2 responses necessary to control the parasite. We previously reported that peripheral blood Tregs are increased in SS/HTLV-1 and correlate with low Th2 responses. We hypothesized that Tregs are also increased at the site of infection in duodenal mucosa.MethodsParaffin embedded duodenal biopsies were obtained from 10 SS/HTLV-1 patients, 3 controls with non-parasitic chronic duodenitis, and 2 healthy controls. Immunohistochemistry was performed using monoclonal antibodies against human CD3, CD8, IgE and FoxP3. The number of cells were counted using a conventional light microscope. The number of CD3+, CD8+, FoxP3+ and IgE positive cells per 0.35 mm2 was measured using ImagePro Plus software comparing areas adjacent or distant from parasite material.ResultsIn patients with SS/HTLV-1, T lymphocyte counts and CD8+ cells were lower in areas adjacent to the parasite compared to non-adjacent areas (CD3+: adjacent: 6.5 [Interquartile range (IQR: 2.8–12.3)]; non-adjacent: 24.5 [IQR: 20.9–34.4]; Mann-Whitney p = 0.0003; CD8+: adjacent: 4.5 [IQR: 2.3–11.8]; non-adjacent: 21 [IQR: 15.3–42.9]; Mann-Whitney p = 0.0011). Tregs cells in the intestines (FoxP3+ expressing cells) were increased in patients with SS/HTLV-1 compared with patients with chronic duodenitis (SS/HTLV-1: 1.5 [IQR: 0.7–2.3]; duodenitis controls: 0 [range 0–0.7]; healthy controls: 0; Mann-Whitney p = 0.034). There was also a trend towards fewer eosinophils adjacent to the parasites. Among SS/HTLV-1 patients the number of IgE expressing cells was increased for in areas not adjacent to the parasite compared to non-adjacent areas (ANOVA, p = 0.001).ConclusionsOur data shows increased Treg cell numbers localized adjacent to the parasites in the duodenum SS/HTLV-1 patients. In addition, other T lymphocytes and IgE expressing cells were decreased adjacent to the parasites, suggesting an important role for Tregs in down-regulating local parasite effector responses.

Delivery of Fall Prevention Interventions for At-Risk Older Adults in Rural Areas: Findings from a National Dissemination.

Falls incidence rates and associated injuries are projected to increase among rural-dwelling older adults, which highlights the need for effective interventions to prevent falls and manage fall-related risks. The purpose of this descriptive study was to identify the geospatial dissemination of eight evidence-based fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Chi, Otago Exercise Program) across the United States (U.S.) in terms of participants enrolled, workshops delivered, and geospatial reach. These dissemination characteristics were compared across three rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas; and, non-metro areas not adjacent to metro areas). Data were analyzed from a national repository of 39 Administration for Community Living (ACL) grantees from 2014–2017 (spanning 22 states). Descriptive statistics were used to assess program reach, delivery-site type, and completion rate by rurality. Geographic information systems (GIS) geospatially represented the collective reach of the eight interventions. Of the 45,812 participants who attended a fall prevention program, 12.7% attended workshops in non-metro adjacent areas and 6.6% attended workshops in non-metro non-adjacent areas. Of the 3755 workshops delivered (in over 550 unique counties), most were delivered in senior centers (26%), residential facilities (20%), healthcare organizations (13%), and faith-based organizations (9%). On average, the workshop attendance/retention rates were consistent across rurality (~70%). Findings highlight the need to diversify the delivery infrastructure for fall prevention programs to adequately serve older adults in rural areas. Ongoing efforts are needed to offer sustainable technical assistance and to develop scalable clinical-community referral systems to increase fall prevention program participation among rural-dwelling older adults.

Integrated vector control of Aedes aegypti mosquitoes around target houses

BackgroundThe developing fetuses of pregnant women are at high risk of developing serious birth defects following Zika virus infections. We applied an Integrated Vector Control (IVC) approach using source reduction, larviciding, and mass trapping with non-insecticidal sticky traps to protect targeted houses by reducing the density of female Aedes aegypti mosquitoes.MethodsWe tested the hypothesis that Ae. aegypti density could be reduced to below three female mosquitoes/trap/week around a target house in the center of a circular area with a 150 m radius using IVC. Two non-adjacent areas within the same neighbourhood were selected and randomly designated as the treatment or control areas. Sentinel Autocidal Gravid Ovitraps (SAGO traps) were placed in each study area and were sampled weekly from May to November, during the 2016 Zika epidemic in Puerto Rico. The experimental design was longitudinal with pre-and post-IVC treatment observations between treatment and control areas, and a partial cross-over design, where IVC was applied to the original control area after 2 months to determine if Ae. aegypti density converged to levels observed in the treatment area. Pools of female Ae. aegypti mosquitoes were analyzed by RT-PCR to detect Zika, dengue and chikungunya virus RNA.ResultsOverall, pre-treatment mosquito densities in the inner (0–50 m; 15.6 mosquitoes/trap/week), intermediate (50–100 m; 18.1) and outer rings (100–150 m; 15.6) were reduced after treatment to 2.8, 4.1, and 4.3 in the inner, middle, and outer rings, respectively. Density at the target house in the treatment area changed from 27.7 mosquitoes/trap/week before IVC to 2.1 after IVC (92.4% reduction), whereas after treating the original control area (cross-over) density changed from 22.4 to 3.5 (84.3% reduction). Vector reductions were sustained in both areas after IVC. Zika virus was detected in Ae. aegypti, but the low incidence of the virus precluded assessing the impact of IVC on Zika transmission during the study.ConclusionsApplying IVC to circular areas that were surrounded by untreated areas significantly decreased the number of mosquitoes around target houses located in the center. Gravid Ae. aegypti females in the center of the 150 m areas fell below threshold levels that possibly protect against novel invading arboviruses, such as chikungunya and Zika.

Histologic Lung Cancer Incidence Rates and Trends Vary by Race/Ethnicity and Residential County.

Lung cancer incidence is higher among non-Hispanic (NH) blacks than among the NH white and Hispanic populations in the United States. However, national cancer estimates may not always reflect the cancer burden in terms of disparities and incidence in small geographic areas, especially urban-rural disparities. Moreover, there is a gap in the literature regarding rural-urban disparities in terms of cancer histologic type. Using population-based cancer registry data-Surveillance, Epidemiology and End Results and National Program of Cancer Registries data-we present age-adjusted histologic rates and trends by race/ethnicity and residential county location at the time of first cancer diagnosis. Rate ratios were calculated to examine racial/ethnic differences in rates. Annual percent change was calculated to measure changes in rates over time. We found that declines in squamous cell carcinoma are occurring fastest in metropolitan counties, whereas rates of adenocarcinoma increased fastest in counties nonadjacent to metropolitan areas. Further, although NH black men have increased lung cancer incidence compared with NH white and Hispanic men in all geographic locations, we found that the degree of the disparity increases with increasing rurality of residence. Finally, we discovered that among women whose lung cancer was diagnosed when they were younger than 55years, the incidence of squamous cell carcinoma and adenocarcinoma was higher for NH blacks than for NH whites. Our results highlight disparities among NH blacks in nonadjacent rural areas. These findings may have significant impact for the implementation of smoking cessation and lung cancer screening programs.

Dissemination of Chronic Disease Self-Management Education (CDSME) Programs in the United States: Intervention Delivery by Rurality.

Background: Alongside the dramatic increase of older adults in the United States (U.S.), it is projected that the aging population residing in rural areas will continue to grow. As the prevalence of chronic diseases and multiple chronic conditions among adults continues to rise, there is additional need for evidence-based interventions to assist the aging population to improve lifestyle behaviors, and self-manage their chronic conditions. The purpose of this descriptive study was to identify the geospatial dissemination of Chronic Disease Self-Management Education (CDSME) Programs across the U.S. in terms of participants enrolled, workshops delivered, and counties reached. These dissemination characteristics were compared across rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas, and non-metro areas not adjacent to metro areas). Methods: This descriptive study analyzed data from a national repository including efforts from 83 grantees spanning 47 states from December 2009 to December 2016. Counts were tabulated and averages were calculated. Results: CDSME Program workshops were delivered in 56.4% of all U.S. counties one or more times during the study period. Of the counties where a workshop was conducted, 50.5% were delivered in non-metro areas. Of the 300,640 participants enrolled in CDSME Programs, 12% attended workshops in non-metro adjacent areas, and 7% attended workshops in non-metro non-adjacent areas. The majority of workshops were delivered in healthcare organizations, senior centers/Area Agencies on Aging, and residential facilities. On average, participants residing in non-metro areas had better workshop attendance and retention rates compared to participants in metro areas. Conclusions: Findings highlight the established role of traditional organizations/entities within the aging services network, to reach remote areas and serve diverse participants (e.g., senior centers). To facilitate growth in rural areas, technical assistance will be needed. Additional efforts are needed to bolster partnerships (e.g., sharing resources and knowledge), marketing (e.g., tailored material), and regular communication among stakeholders.