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Mensah JA, Fei-Zhang DJ, Rossen JL, Rahmani B, Bentrem DJ, Stein JD, French DD. Assessment of Social Vulnerabilities of Care and Prognosis in Adult Ocular Melanomas in the US. Ann Surg Oncol 2024; 31:3302-3313. [PMID: 38418655 PMCID: PMC11003832 DOI: 10.1245/s10434-024-15038-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Prior works have studied the impact of social determinants on various cancers but there is limited analysis on eye-orbit cancers. Current literature tends to focus on socioeconomic status and race, with sparse analysis of interdisciplinary contributions. We examined social determinants as measured by the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), quantifying eye and orbit melanoma disparities across the United States. METHODS A retrospective review of 15,157 patients diagnosed with eye-orbit cancers in the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2017 was performed, extracting 6139 ocular melanomas. SVI scores were abstracted and matched to SEER patient data, with scores generated by weighted averages per population density of county's census tracts. Primary outcome was months survived, while secondary outcomes were advanced staging, high grading, and primary surgery receipt. RESULTS With increased total SVI score, indicating more vulnerability, we observed significant decreases of 23.1% in months survival for melanoma histology (p < 0.001) and 19.6-39.7% by primary site. Increasing total SVI showed increased odds of higher grading (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.02-1.43) and decreased odds of surgical intervention (OR 0.94, 95% CI 0.92-0.96). Of the four themes, higher magnitude contributions were observed with socioeconomic status (26.0%) and housing transportation (14.4%), while lesser magnitude contributions were observed with minority language status (13.5%) and household composition (9.0%). CONCLUSIONS Increasing social vulnerability, as measured by the CDC SVI and its subscores, displayed significant detrimental trends in prognostic and treatment factors for adult eye-orbit melanoma. Subscores quantified which social determinants contributed most to disparities. This lays groundwork for providers to target the highest-impact social determinant for non-clinical factors in patient care.
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Affiliation(s)
- Joshua A Mensah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - David J Fei-Zhang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer L Rossen
- Division of Pediatric Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Bahram Rahmani
- Division of Pediatric Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - David J Bentrem
- Division of Surgical Oncology and Medical Social Sciences, Department of Surgery, Chicago, IL, USA
| | - Joshua D Stein
- Division of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Dustin D French
- Departments of Ophthalmology and Medical Social Sciences, Feinberg School of Medicine, Chicago, IL, USA
- Health Services Research and Development Service, Veteran Health Administration, Edward Hines Jr. VA Hospital, Hines, IL, USA
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Rashid Z, Munir MM, Woldesenbet S, Khan MMM, Khalil M, Endo Y, Tsilimigras DI, Dillhoff M, Ejaz A, Pawlik TM. Association between social determinants of health and delayed postoperative adjuvant therapy among patients undergoing resection of pancreatic cancer. J Surg Oncol 2024; 129:850-859. [PMID: 38151795 DOI: 10.1002/jso.27571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Pancreatic cancer (PDAC) requires a multimodality approach. We sought to define the association between social determinants of health (SDOH) and delayed or nonreceipt of adjuvant chemotherapy (aCT) among patients undergoing PDAC resection. METHODS Data on patients who underwent PDAC resection between 2014 and 2020 were identified from Medicare Standard Analytic Files and merged with the county-level social vulnerability index (SVI). Mediation analysis defined the association between SVI subthemes and aCT receipt. RESULTS Among 24 078 patients, 47.7% received timely aCT, 17.7% received delayed aCT, and 34.6% did not receive any aCT. High SVI was associated with delay (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.10-1.34) and nonreceipt of aCT (OR 1.30, 95% CI 1.20-1.41) (both p < 0.05). 73.1% of the variation in timely aCT receipt was directly attributable to SVI, whereas 26.9% of the effect was due to indirect mediators including hospital volume (6.4%), length-of-stay (7.9%) and postoperative complications (12.6%). Socioeconomic status (delayed aCT: OR 1.25, 95% CI 1.13-1.38; nonreceipt aCT: OR 1.25, 95% CI 1.15-1.36) and household composition and disability (delayed aCT: OR 1.30, 95% CI 1.17-1.43; nonreceipt aCT: OR 1.19, 95% CI 1.09-1.29) were associated with receipt of aCT (both p < 0.001). CONCLUSIONS Most of the disparities in receipt of aCT after PDAC surgery are driven by underlying SDOH such as SVI.
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Affiliation(s)
- Zayed Rashid
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad M Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad M M Khan
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mujtaba Khalil
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Benoit TJ, Kim Y, Deng Y, Li Z, Harding L, Wiegand R, Deng X, Jones JM, Ronaldo I, Clarke KEN. Association Between Social Vulnerability and SARS-CoV-2 Seroprevalence in Specimens Collected From Commercial Laboratories, United States, September 2021-February 2022. Public Health Rep 2024:333549231223140. [PMID: 38357883 DOI: 10.1177/00333549231223140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE We conducted a national US study of SARS-CoV-2 seroprevalence by Social Vulnerability Index (SVI) that included pediatric data and compared the Delta and Omicron periods during the COVID-19 pandemic. The objective of the current study was to assess the association between SVI and seroprevalence of infection-induced SARS-CoV-2 antibodies by period (Delta vs Omicron) and age group. METHODS We used results of infection-induced SARS-CoV-2 antibody assays of clinical sera specimens (N = 406 469) from 50 US states from September 2021 through February 2022 to estimate seroprevalence overall and by county SVI tercile. Bivariate analyses and multilevel logistic regression models assessed the association of seropositivity with SVI and its themes by age group (0-17, ≥18 y) and period (Delta: September-November 2021; Omicron: December 2021-February 2022). RESULTS Aggregate infection-induced SARS-CoV-2 antibody seroprevalence increased at all 3 SVI levels; it ranged from 25.8% to 33.5% in September 2021 and from 53.1% to 63.5% in February 2022. Of the 4 SVI themes, socioeconomic status had the strongest association with seroprevalence. During the Delta period, we found significantly more infections per reported case among people living in a county with high SVI (odds ratio [OR] = 2.76; 95% CI, 2.31-3.21) than in a county with low SVI (OR = 1.65; 95% CI, 1.33-1.97); we found no significant difference during the Omicron period. Otherwise, findings were consistent across subanalyses by age group and period. CONCLUSIONS Among both children and adults, and during both the Delta and Omicron periods, counties with high SVI had significantly higher SARS-CoV-2 antibody seroprevalence than counties with low SVI did. These disparities reinforce SVI's value in identifying communities that need tailored prevention efforts during public health emergencies and resources to recover from their effects.
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Affiliation(s)
- Tina J Benoit
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Zheng Li
- Office of Capacity Development and Applied Prevention Science, Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA
| | | | - Ryan Wiegand
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jefferson M Jones
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kristie E N Clarke
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Nieri CA, Davies C, Luttrell JB, Sheyn A. Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes. Laryngoscope 2024; 134:954-962. [PMID: 38050924 DOI: 10.1002/lary.30836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/25/2023] [Accepted: 05/24/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To investigate the impact of neighborhood-level social vulnerability on pediatric tonsillectomy outcomes. METHODS This single-center retrospective cohort study included tonsillectomies performed on children aged 1 to 18 between August 2019 and August 2020. Geographic information systems were used to geocode addresses, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores to each patient. For categorical variables, two-sided Pearson chi-square tests were used, whereas for continuous variables, paired t-tests, means, and standard deviations were calculated. SVI and its four subthemes were investigated using binomial logistic regressions to determine their impact on post-T&A complications and readmissions. RESULTS The study included 397 patients, with 52 having complications (13.1%) and 33 (8.3%) requiring readmissions due to their complications. Controlling for age, gender, race, insurance status, surgical indication, comorbidities, obesity, and obstructive sleep apnea, postoperative complications were associated with high overall SVI (odds ratio [OR] 5.086, 95% confidence interval [CI] 1.128-22.938), high socioeconomic vulnerability (SVI theme 1, OR 6.003, 95% CI 1.270-28.385), and high house composition vulnerability (SVI theme 2, OR 6.340, 95% CI 1.275-31.525). Readmissions were also associated with high overall SVI (10.149, 95% CI 1.293-79.647) and high housing/transportation vulnerability (SVI theme 4, OR 5.657, 95% CI 1.089-29.396). CONCLUSION Social vulnerability at the neighborhood level is linked to poorer surgical outcomes in otherwise healthy children, suggesting a target for community-based interventions. Because of the increased risk, it may have implications for preoperative decision-making, treatment plans, and clinic follow-ups. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:954-962, 2024.
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Affiliation(s)
- Chad A Nieri
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Camron Davies
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Jordan B Luttrell
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Anthony Sheyn
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
- Division of Otolaryngology, LeBonheur Children's Hospital, Memphis, Tennessee, U.S.A
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Cao B, Niu H, Hao J, Yang X, Ye Z. Spatial Visual Imagery ( SVI)-Based Electroencephalograph Discrimination for Natural CAD Manipulation. Sensors (Basel) 2024; 24:785. [PMID: 38339501 PMCID: PMC10856899 DOI: 10.3390/s24030785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
With the increasing demand for natural interactions, people have realized that an intuitive Computer-Aided Design (CAD) interaction mode can reduce the complexity of CAD operation and improve the design experience. Although interaction modes like gaze and gesture are compatible with some complex CAD manipulations, they still require people to express their design intentions physically. The brain contains design intentions implicitly and controls the corresponding body parts that execute the task. Therefore, building an end-to-end channel between the brain and computer as an auxiliary mode for CAD manipulation will allow people to send design intentions mentally and make their interaction more intuitive. This work focuses on the 1-D translation scene and studies a spatial visual imagery (SVI) paradigm to provide theoretical support for building an electroencephalograph (EEG)-based brain-computer interface (BCI) for CAD manipulation. Based on the analysis of three spatial EEG features related to SVI (e.g., common spatial patterns, cross-correlation, and coherence), a multi-feature fusion-based discrimination model was built for SVI. The average accuracy of the intent discrimination of 10 subjects was 86%, and the highest accuracy was 93%. The method proposed was verified to be feasible for discriminating the intentions of CAD object translation with good classification performance. This work further proves the potential of BCI in natural CAD manipulation.
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Affiliation(s)
- Beining Cao
- School of Mechanical Engineering, Beijing Institute of Technology, Beijing 100081, China; (B.C.); (H.N.); (X.Y.); (Z.Y.)
| | - Hongwei Niu
- School of Mechanical Engineering, Beijing Institute of Technology, Beijing 100081, China; (B.C.); (H.N.); (X.Y.); (Z.Y.)
- Yangtze Delta Region Academy, Beijing Institute of Technology, Jiaxing 314019, China
- Key Laboratory of Industry Knowledge & Data Fusion Technology and Application, Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jia Hao
- School of Mechanical Engineering, Beijing Institute of Technology, Beijing 100081, China; (B.C.); (H.N.); (X.Y.); (Z.Y.)
- Yangtze Delta Region Academy, Beijing Institute of Technology, Jiaxing 314019, China
- Key Laboratory of Industry Knowledge & Data Fusion Technology and Application, Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Xiaonan Yang
- School of Mechanical Engineering, Beijing Institute of Technology, Beijing 100081, China; (B.C.); (H.N.); (X.Y.); (Z.Y.)
- Yangtze Delta Region Academy, Beijing Institute of Technology, Jiaxing 314019, China
- Key Laboratory of Industry Knowledge & Data Fusion Technology and Application, Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Zinian Ye
- School of Mechanical Engineering, Beijing Institute of Technology, Beijing 100081, China; (B.C.); (H.N.); (X.Y.); (Z.Y.)
- Yangtze Delta Region Academy, Beijing Institute of Technology, Jiaxing 314019, China
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Gant Z, Dailey A, Hu X, Lyons SJ, Okello A, Elenwa F, Johnson AS. A Census Tract-Level Examination of Diagnosed HIV Infection and Social Vulnerability among Black/African American, Hispanic/Latino, and White Adults, 2018: United States. J Racial Ethn Health Disparities 2023; 10:2792-2801. [PMID: 36383342 PMCID: PMC9667837 DOI: 10.1007/s40615-022-01456-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND To reduce health disparities and improve the health of Americans overall, addressing community-level social and structural factors, such as social vulnerability, may help explain the higher rates of HIV diagnoses among and between race/ethnicity groups. METHODS Data were obtained from CDC's National HIV Surveillance System (NHSS) and the CDC/ATSDR social vulnerability index (SVI). NHSS data for Black, Hispanic/Latino, and White adults with HIV diagnosed in 2018 were linked to SVI data. To measure the relative disparity, rate ratios (RRs) with 95% CIs were calculated to examine the relative difference comparing census tracts with the lowest SVI scores (quartile 1, Q1) to those with the highest SVI scores (quartile 4, Q4) by sex assigned at birth for age group and region of residence. Differences in the numbers of diagnoses across the quartiles were analyzed by sex assigned at birth and transmission category. RESULTS There were 13,807 Black, 8747 Hispanic/Latino, and 8325 White adults who received a diagnosis of HIV infection in the United States in 2018-with the highest HIV diagnosis rates among adults who lived in census tracts with the highest vulnerability (Q4). For each race/ethnicity and both sexes, the rate of HIV diagnoses increased as social vulnerability increased. The highest disparities in HIV diagnosis rates by SVI were among persons who inject drugs, and the highest within-group RRs were typically observed among older persons and persons residing in the Northeast. CONCLUSION To reach the goals of several national HIV initiatives, efforts are needed to address the social vulnerability factors that contribute to racial and ethnic disparities in acquiring HIV and receiving care and treatment.
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Affiliation(s)
- Zanetta Gant
- HIV Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-47, Atlanta, GA, 30329-4027, USA.
| | - André Dailey
- HIV Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-47, Atlanta, GA, 30329-4027, USA
| | - Xiaohong Hu
- HIV Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-47, Atlanta, GA, 30329-4027, USA
| | - Shacara Johnson Lyons
- HIV Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-47, Atlanta, GA, 30329-4027, USA
| | - Amanda Okello
- HIV Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-47, Atlanta, GA, 30329-4027, USA
| | - Faith Elenwa
- HIV Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-47, Atlanta, GA, 30329-4027, USA
| | - Anna Satcher Johnson
- HIV Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-47, Atlanta, GA, 30329-4027, USA
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Nyachoti DO, Ranjit N, Ramphul R, Whigham LD, Springer AE. Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis. Int J Environ Res Public Health 2023; 20:6985. [PMID: 37947543 PMCID: PMC10647229 DOI: 10.3390/ijerph20216985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Despite the key role of social vulnerability such as economic disadvantage in health outcomes, research is limited on the impact of social vulnerabilities on COVID-19-related deaths, especially at the state and county level in the USA. METHODS We conducted a cross-sectional ecologic analysis of COVID-19 mortality by the county-level Minority Health Social Vulnerability Index (MH SVI) and each of its components in Texas. Negative binomial regression (NBR) analyses were used to estimate the association between the composite MH SVI (and its components) and COVID-19 mortality. RESULTS A 0.1-unit increase in the overall MH SVI (IRR, 1.27; 95% CI, 1.04-1.55; p = 0.017) was associated with a 27% increase in the COVID-19 mortality rate. Among the MH SVI component measures, only low socioeconomic status (IRR, 1.55; 95% CI, 1.28-1.89; p = 0.001) and higher household composition (e.g., proportion of older population per county) and disability scores (IRR, 1.47; 95% CI, 1.29-1.68; p < 0.001) were positively associated with COVID-19 mortality rates. CONCLUSIONS This study provides further evidence of disparities in COVID-19 mortality by social vulnerability and can inform decisions on the allocation of social resources and services as a strategy for reducing COVID-19 mortality rates and similar pandemics in the future.
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Affiliation(s)
- Dennis Ogeto Nyachoti
- Epidemiology and Surveillance Unit, Texas Department of State Health Services, 201 W Howard Ln, Austin, TX 78753, USA
- Department of Health Promotion and Behavioral Sciences, Center for Community Health Impact, The University of Texas Health Science Center at Houston School of Public Health, 5130 Gateway Boulevard East MCA 110, El Paso, TX 79905, USA;
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe, Austin, TX 78701, USA;
| | - Ryan Ramphul
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA;
| | - Leah D. Whigham
- Department of Health Promotion and Behavioral Sciences, Center for Community Health Impact, The University of Texas Health Science Center at Houston School of Public Health, 5130 Gateway Boulevard East MCA 110, El Paso, TX 79905, USA;
| | - Andrew E. Springer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe, Austin, TX 78701, USA;
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Szabo Z, Fabo C, Szarvas M, Matuz M, Oszlanyi A, Farkas A, Paroczai D, Lantos J, Furak J. Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years. J Clin Med 2023; 12:6457. [PMID: 37892595 PMCID: PMC10607362 DOI: 10.3390/jcm12206457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. METHODS For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. RESULTS Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4-92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81-100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20-140), 17.55 (0-115) and 57.73 (0-130) min, respectively. CONCLUSIONS Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%).
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Affiliation(s)
- Zsolt Szabo
- Doctoral School of Multidisciplinary Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Csongor Fabo
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Matyas Szarvas
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Maria Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Adam Oszlanyi
- Department of Anesthesiology and Intensive Therapy, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Attila Farkas
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, H-9700 Szombathely, Hungary
| | - Dora Paroczai
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Jozsef Furak
- Department of Surgery, University of Szeged, H-6720 Szeged, Hungary
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Stevens J, Reppucci ML, Pickett K, Acker S, Carmichael H, Velopulos CG, Bensard D, Kulungowski A. Using the Social Vulnerability Index to Examine Disparities in Surgical Pediatric Trauma Patients. J Surg Res 2023; 287:55-62. [PMID: 36868124 DOI: 10.1016/j.jss.2023.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 12/31/2022] [Accepted: 01/27/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION The Social Vulnerability Index (SVI) is a composite measure geocoded at the census tract level that has the potential to identify target populations at risk for postoperative surgical morbidity. We applied the SVI to examine demographics and disparities in surgical outcomes in pediatric trauma patients. METHODS Surgical pediatric trauma patients (≤18-year-old) at our institution from 2010 to 2020 were included. Patients were geocoded to identify their census tract of residence and estimated SVI and were stratified into high (≥70th percentile) and low (<70th percentile) SVI groups. Demographics, clinical data, and outcomes were compared using Kruskal-Wallis and Fisher's exact tests. RESULTS Of 355 patients included, 21.4% had high SVI percentiles while 78.6% had low SVI percentiles. Patients with high SVI were more likely to have government insurance (73.7% versus 37.2%, P < 0.001), be of minority race (49.8% versus 19.1%, P < 0.001), present with penetrating injuries (32.9% versus 19.7%, P = 0.007), and develop surgical site infections (3.9% versus 0.4%, P = 0.03) compared to the low SVI group. CONCLUSIONS The SVI has the potential to examine health care disparities in pediatric trauma patients and identify discrete at-risk target populations for preventative resources allocation and intervention. Future studies are necessary to determine the utility of this tool in additional pediatric cohorts.
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Affiliation(s)
- Jenny Stevens
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
| | - Marina L Reppucci
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Kaci Pickett
- The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Shannon Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Heather Carmichael
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Denis Bensard
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Ann Kulungowski
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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10
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Bastos LAVM, Bichara JLP, Nascimento GS, Villela PB, de Oliveira GMM. Mortality from diseases of the circulatory system in Brazil and its relationship with social determinants focusing on vulnerability: an ecological study. BMC Public Health 2022; 22:1947. [PMID: 36266678 PMCID: PMC9583513 DOI: 10.1186/s12889-022-14294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Deaths from diseases of the circulatory system and ischemic heart diseases are declining, but slowly in developing countries, emphasizing its probable relationship with determinants of social vulnerability. Objectives To analyze the temporal progression of mortality rates of diseases of the circulatory system and ischemic heart diseases from 1980 to 2019 and the association of the rates with the Municipal Human Development Index and Social Vulnerability Index in Brazil. Methods We estimated the crude and standardized mortality rates of diseases of the circulatory system and ischemic heart diseases and analyzed the relationship between the obtained data and the Municipal Human Development Index and Social Vulnerability Index. Data on deaths and population were obtained from the DATASUS. The Municipal Human Development Index and the Social Vulnerability Index of each federative unit were extracted from the websites Atlas Brazil and Atlas of Social Vulnerability, respectively. Results The age-standardized mortality rates of diseases of the circulatory system and ischemic heart diseases showed a downward trend nationwide, which was unequal across the federative units. There was an inversely proportional relationship between the standardized mortality rates of diseases of the circulatory system and ischemic heart diseases and the Municipal Human Development Index. The downward mortality trend was observed when the indices were greater than 0.70 and 0.75, respectively. The Social Vulnerability Index was directly proportional to the standardized mortality rates of diseases of the circulatory system and ischemic heart diseases. An upward mortality trend was observed with a Social Vulnerability Index greater than 0.35. Conclusions Social determinants represented by the Municipal Human Development Index and the Social Vulnerability Index were related to mortality from diseases of the circulatory system and ischemic heart diseases across the Brazilian federative units. The units with most development and least social inequalities had the lowest mortality from these causes. The most vulnerable die the most. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14294-3.
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Affiliation(s)
| | | | | | - Paolo B Villela
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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11
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Jain V, Al Rifai M, Khan SU, Kalra A, Rodriguez F, Samad Z, Pokharel Y, Misra A, Sperling LS, Rana JS, Ullah W, Medhekar A, Virani SS. Association Between Social Vulnerability Index and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study. J Am Heart Assoc 2022; 11:e024414. [PMID: 35904206 PMCID: PMC9375494 DOI: 10.1161/jaha.121.024414] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Social and environmental factors play an important role in the rising health care burden of cardiovascular disease. The Centers for Disease Control and Prevention developed the Social Vulnerability Index (SVI) from US census data as a tool for public health officials to identify communities in need of support in the setting of a hazardous event. SVI (ranging from a least vulnerable score of 0 to a most vulnerable score of 1) ranks communities on 15 social factors including unemployment, minoritized groups status, and disability, and groups them under 4 broad themes: socioeconomic status, housing and transportation, minoritized groups, and household composition. We sought to assess the association of SVI with self‐reported prevalent cardiovascular comorbidities and atherosclerotic cardiovascular disease (ASCVD). Methods and Results We performed a retrospective cohort analysis of adults (≥18 years) in the Behavioral Risk Factor Surveillance System 2016 to 2019. Data regarding self‐reported prevalent cardiovascular comorbidities (including diabetes, hypertension, hyperlipidemia, smoking, substance use), and ASCVD was captured using participants' response to a structured telephonic interview. We divided states on the basis of the tertile of SVI (first—participant lives in the least vulnerable group of states, 0–0.32; to third—participant lives in the most vulnerable group of states, 0.54–1.0). Multivariable logistic regression models adjusting for age, race and ethnicity, sex, employment, income, health care coverage, and association with federal poverty line were constructed to assess the association of SVI with cardiovascular comorbidities. Our study sample consisted of 1 745 999 participants ≥18 years of age. States in the highest (third) tertile of social vulnerability had predominantly Black and Hispanic adults, lower levels of education, lower income, higher rates of unemployment, and higher rates of prevalent comorbidities including hypertension, diabetes, chronic kidney disease, hyperlipidemia, substance use, and ASCVD. In multivariable logistic regression models, individuals living in states in the third tertile of SVI had higher odds of having hypertension (odds ratio (OR), 1.14 [95% CI, 1.11–1.17]), diabetes (OR, 1.12 [95% CI, 1.09–1.15]), hyperlipidemia (OR, 1.09 [95% CI, 1.06–1.12]), chronic kidney disease (OR, 1.17 [95% CI, 1.12–1.23]), smoking (OR, 1.05 [95% CI, 1.03–1.07]), and ASCVD (OR, 1.15 [95% CI, 1.12–1.19]), compared with those living in the first tertile of SVI. Conclusions SVI varies across the US states and is associated with prevalent cardiovascular comorbidities and ASCVD, independent of age, race and ethnicity, sex, employment, income, and health care coverage. SVI may be a useful assessment tool for health policy makers and health systems researchers examining multilevel influences on cardiovascular‐related health behaviors and identifying communities for targeted interventions pertaining to social determinants of health.
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Affiliation(s)
- Vardhmaan Jain
- Department of Internal Medicine Cleveland Clinic Foundation Cleveland OH
| | - Mahmoud Al Rifai
- Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX
| | - Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center Indiana University School of Medicine Indianapolis IN
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute Stanford University School of Medicine Stanford CA
| | - Zainab Samad
- Department of Cardiovascular Medicine Aga Khan University Karachi Pakistan
| | - Yashashwi Pokharel
- Section of Cardiovascular Medicine, Department of Medicine Wake Forest Baptist Health Winston-Salem NC
| | - Arunima Misra
- Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX
| | - Laurence S Sperling
- Division of Cardiovascular Medicine Emory University School of Medicine Atlanta GA
| | - Jamal S Rana
- Division of Cardiovascular Medicine Kaiser Permanente Oakland Medical Center Oakland CA
| | - Waqas Ullah
- Division of Cardiovascular Medicine Thomas Jefferson University Hospital Philadelphia PA
| | - Ankit Medhekar
- Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX
| | - Salim S Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX.,Section of Health Services Research, Department of Medicine Baylor College of Medicine Houston TX.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center Houston TX
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12
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Flammia RS, Hoeh B, Sorce G, Chierigo F, Hohenhorst L, Tian Z, Goyal JA, Leonardo C, Briganti A, Graefen M, Terrone C, Saad F, Shariat SF, Montorsi F, Chun FKH, Gallucci M, Karakiewicz PI. Contemporary seminal vesicle invasion rates in NCCN high-risk prostate cancer patients. Prostate 2022; 82:1051-1059. [PMID: 35403734 PMCID: PMC9325368 DOI: 10.1002/pros.24350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/28/2022] [Accepted: 03/22/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Contemporary seminal vesicle invasion (SVI) rates in National Cancer Comprehensive Network (NCCN) high-risk prostate cancer (PCa) patients are not well known but essential for treatment planning. We examined SVI rates according to individual patient characteristics for purpose of treatment planning. MATERIALS AND METHODS Within Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), 4975 NCCN high-risk patients were identified. In the development cohort (SEER geographic region of residence: South, North-East, Mid-West, n = 2456), we fitted a multivariable logistic regression model predicting SVI. Its accuracy, calibration, and decision curve analyses (DCAs) were then tested versus previous models within the external validation cohort (SEER geographic region of residence: West, n = 2519). RESULTS Out of 4975 patients, 28% had SVI. SVI rate ranged from 8% to 89% according to clinical T stage, prostate-specific antigen (PSA), biopsy Gleason Grade Group and percentage of positive biopsy cores. In the development cohort, these variables were independent predictors of SVI. In the external validation cohort, the current model achieved 77.6% accuracy vs 73.7% for Memorial Sloan Kettering Cancer Centre (MSKCC) vs 68.6% for Gallina et al. Calibration was better than for the two alternatives: departures from ideal predictions were 6.0% for the current model vs 9.8% for MSKCC vs 38.5% for Gallina et al. In DCAs, the current model outperformed both alternatives. Finally, different nomogram cutoffs allowed to discriminate between low versus high SVI risk patients. CONCLUSIONS More than a quarter of NCCN high-risk PCa patients harbored SVI. Since SVI positivity rate varies from 8% to 89%, the currently developed model offers a valuable approach to distinguish between low and high SVI risk patients.
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Affiliation(s)
- Rocco S. Flammia
- Department of Maternal‐Child and Urological SciencesSapienza University Rome, Policlinico Umberto I HospitalRomeItaly
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
- Department of UrologyUniversity Hospital FrankfurtFrankfurt am MainGermany
| | - Gabriele Sorce
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
- Division of Experimental Oncology, Department of UrologyUrological Research Institute, IRCCS San Raffaele Scientific InstituteMilanItaly
| | - Francesco Chierigo
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
- Department of Surgical and Diagnostic Integrated SciencesUniversity of GenovaGenovaItaly
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
- Martini‐Klinik Prostate Cancer CenterUniversity Hospital Hamburg‐EppendorfHamburgGermany
| | - Zhen Tian
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
| | - Jordan A. Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
| | - Costantino Leonardo
- Department of Maternal‐Child and Urological SciencesSapienza University Rome, Policlinico Umberto I HospitalRomeItaly
| | - Alberto Briganti
- Division of Experimental Oncology, Department of UrologyUrological Research Institute, IRCCS San Raffaele Scientific InstituteMilanItaly
| | - Markus Graefen
- Martini‐Klinik Prostate Cancer CenterUniversity Hospital Hamburg‐EppendorfHamburgGermany
- Department of UrologyUniversity Hospital Hamburg‐EppendorfHamburgGermany
| | - Carlo Terrone
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
| | - Shahrokh F. Shariat
- Department of UrologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
- Department of UrologyUniversity of Texas SouthwesternDallasTexasUSA
- Department of Urology, Second Faculty of MedicineCharles UniversityPragueCzech Republic
- Department of Urology, Institute for Urology and Reproductive HealthSechenov UniversityMoscowRussia
- Department of Urology, Hourani Center for Applied Scientific ResearchAl‐Ahliyya Amman UniversityAmmanJordan
- Department of Urology, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Francesco Montorsi
- Division of Experimental Oncology, Department of UrologyUrological Research Institute, IRCCS San Raffaele Scientific InstituteMilanItaly
| | - Felix K. H. Chun
- Department of UrologyUniversity Hospital FrankfurtFrankfurt am MainGermany
| | - Michele Gallucci
- Department of Maternal‐Child and Urological SciencesSapienza University Rome, Policlinico Umberto I HospitalRomeItaly
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montréal Health CenterMontréalQuébecCanada
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Roche C, Donnaz S, Murthy S, Wett B. Biological process architecture in continuous-flow activated sludge by gravimetry: Controlling densified biomass form and function in a hybrid granule-floc process at Dijon WRRF, France. Water Environ Res 2022; 94:e1664. [PMID: 34806253 DOI: 10.1002/wer.1664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
Full-scale demonstration of activated sludge conversion into a granule-floc hybrid process was implemented in Dijon (France) water resource recovery facility (WRRF). Biomass densification was achieved based on external gravimetric selection using hydrocyclones within continuous-flow anaerobic-anoxic-oxic (A2 O) biological nutrient removal (BNR) bioreactor. The goal was to optimize settleability of biological sludge by lowering and stabilizing sludge volume index (SVI) to improve process robustness and resiliency. Process proved to stabilize operation and to uncouple the total solids residence time (SRT) between floc and granule morphologies. The densified biomass initially produced stable SVI < 100 ml/g for a period of 4 months and thereafter a steady state year-round SVI below 50 ml/g, including the winter period during which the control train SVI expansion >200 ml/g. The densified biomass successfully broke the vicious cycle of interannual bulking. Form and function interrelationship is proposed for the densified biomass (hybrid floc-granule). The concept of biological architecture is proposed as the purposeful control of granule and floc proportions, with a proposed "form factor" ratio of 1:2 granule to floc, that produce a "SRT uncoupling function factor" ratio of 4:1 granule to floc, further resulting in very stable settling and effluent functionalities. PRACTITIONER POINTS: Controlling granule-floc proportions allows for sludge volume index (SVI) operational adjustment, which further allows for increased clarified design accuracy. One-third aggregates dramatically improved settling characteristics: 20% and 35% of AGS ensures SVIs below 100 and 50 ml/g, respectively. Densified biomass enables new SRT and clarifier flux rates approaches for engineering and operation practices: Doubling typical surface loading rates from 6.0-8.5 to 15-20 kg m-2 h-1 and surface overflow rates from 0.6-0.8 to 1.5-2.4 m/h SRT uncoupling of 1:4 is achieved between floc and granule, enabling specific niche environment for fast and slow growing organisms.
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14
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Abdelaziz HA, Fouad M, Mossad M. Upgrading sequencing batch reactor using attached biofilm. Water Environ Res 2021; 93:1700-1713. [PMID: 33720481 DOI: 10.1002/wer.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
A conventional sequencing batch reactor (SBR) was upgraded using fixed biofilm carriers with a specific surface area around 18 m2 m-3 . The upgraded SBR was investigated to remove phenol from high strength wastewater operated under various operational conditions. The operational conditions used were variable volume exchange ratio (VER) up to 75%, hydraulic retention time (HRT) from (10.7-21.3 hr), aeration time (from 2 to 8 hr), and initial phenol concentration up to 600 mg L-1 . It was found that the upgraded SBR increased the removal efficiencies of biological oxygen demand (BOD5 ), chemical oxygen demand (COD), and total suspended solids (TSS) by about 10% using high strength wastewater without phenol compared to SBR. Furthermore, the removal rate of phenol for the upgraded SBR was higher than conventional SBR by about 18% at 600 mg L- of initial phenol concentration under the same operational conditions. Compared to the conventional SBR, the upgraded version reduced the aeration step by 25% and achieved higher removal efficiency of phenol. Moreover, it reduced the excess sludge by about 23% and enhanced its properties by lowering the sludge volume index (SVI) by about 33%. PRACTITIONER POINTS: Upgrading conventional SBR by adding biofilm carriers is necessary for wastewater treatment with high strength wastewater. The upgraded SBR has a higher resistance toward phenol compound due to the presence of the attached biofilm. The upgraded SBR enhances sludge settling properties, decreases the amount of excess sludge, and also reduces the start-up period. The number of cycles per day by upgraded SBR was more than the conventional SBR by 15%. The upgraded SBR is an effective system and has good operational stability.
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Affiliation(s)
| | - Moharram Fouad
- Public Works Department, Faculty of engineering, Mansoura University, Mansoura, Egypt
| | - Mohamed Mossad
- Public Works Department, Faculty of engineering, Mansoura University, Mansoura, Egypt
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15
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Regmi MR, Tandan N, Parajuli P, Bhattarai M, Maini R, Kulkarni A, Robinson R. Social Vulnerability Indices as a Risk Factor for Heart Failure Readmissions. Clin Med Res 2021; 19:116-122. [PMID: 34531268 PMCID: PMC8445658 DOI: 10.3121/cmr.2021.1603] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/05/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022]
Abstract
Objectives: The objective of our study was to use the parameters of social vulnerability index (SVI) to observe their association with the 30-day hospital readmissions in the heart failure population.Methods: Data required for analysis were extracted from the electronic medical record. The geographic SVI data was then merged with the clinical data. Qualitative variables and reported as frequency and quantitative variables and reported as the mean ± standard deviation. Variables from univariate analysis with a P value of ≤ 0.10 were evaluated using multivariate logistic regression with stepwise backward variable selection and receiver operating curve (ROC) analysis.Results: The odds ratio of readmission predicted by HOSPITAL score was 1.137 (P value = 0.004, 95% CI = 1.041-1.241). SVI parameter recording disability showed odds ratio of 1.521 (P value = 0.006, 95% CI = 1.125-2.058) and SVI parameter tracking vehicle ownership showed odds ratio of 15.355 (P value = 0.014, 95% CI = 1.755 - 134.383). The ROCs were generated for three scenarios: (i) HOSPITAL score only which had area under the curve (AUC) of 0.702 (P value = 0.015), (ii) SVI indicators tracking vehicle ownership and disability resulted in the AUC of 0.589 (P value = 0.016), and (iii) all of the above combined increased the AUC increased to 0.718 (P value = 0.015).Conclusions: Two social parameters (limited vehicle access and prevalence of disability) from the SVI showed a strong association with 30-day hospital readmissions.
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Affiliation(s)
- Manjari Rani Regmi
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nitin Tandan
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Priyanka Parajuli
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Mukul Bhattarai
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Ruby Maini
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Abhishek Kulkarni
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Robert Robinson
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
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16
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Rodríguez-Villar S, Kraut JA, Arévalo-Serrano J, Sakka SG, Harris C, Awad I, Toolan M, Vanapalli S, Collins A, Spataru A, Eiben P, Recea V, Brathwaite-Shirley C, Thompson L, Gurung B, Reece-Anthony R. Systemic acidemia impairs cardiac function in critically Ill patients. EClinicalMedicine 2021; 37:100956. [PMID: 34258569 PMCID: PMC8255172 DOI: 10.1016/j.eclinm.2021.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/29/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acidemia, is associated with reduced cardiac function in animals, but no studies showing an effect of acidemia on cardiac function in humans are reported. In the present study, we examined the effect of acidemia on cardiac function assessed with transpulmonary thermodilution technique with integrated pulse contour analysis (Pulse Contour Cardiac Output, PiCCO™) in a large cohort of critically ill patients. METHODS This was a prospective multicenter observational cross-sectional study of 297 patients from 6 intensive care units in London, England selected from all patients admitted consecutively between May 2018 and March 2019. Measurements of lowest plasma pH and concurrent assessment of cardiac function were obtained. FINDINGS There was a significant difference between two pH categories (pH ≤ 7.28 vs. pH > 7.28) for the following variables of cardiac function: SVI (difference in means 32.7; 95% CI: 21 to 45 mL/m2; p < 0.001); GEF (18; 95% CI: 11 to 26%; p < 0.001), dPmax (-331; 95% CI: -510 to -153 mmHg/s; p = 0.001), CFI (0.7; 95% CI: 0.2 to 1.3 1/min; p = 0.01) and CPI (0.09; 95% CI: 0.03 to 0.15 W/m2; p < 0.001). However, there was no significant difference in CI (0.13; 95% CI: -0.20 to 0.47 L/min/m2; p = 0.12) between the pH categories. Also, a significant relationship was found between the quantitative pH and the following variables: SVI (132; 95% CI: 77 to 188 mL/m2; p < 0.001), GEF (74.7; 95% CI: 37.1 to 112.4%; p < 0.001), dPmax (-1587; 95% CI: -2361 to -815 mmHg/s; p < 0.001), CFI (3.5; 95% CI: 0.9 to 6.1 /min; p = 0.009), CPI (0.62; 95% CI: 0.36 to 0.88 W/m2; p < 0.001) and CI (regression coefficient 1.96; 95% CI:0.45 to 3.47 L/min/m2; p = 0.01). INTERPRETATION Acidemia is associated with impaired cardiac function in seriously ill patients hospitalized in the intensive care unit supporting the potential value of early diagnosis and improvement of arterial pH in these patients. FUNDING The study was partially supported by unrestricted funds from the UCLA School of Medicine.
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Affiliation(s)
- S Rodríguez-Villar
- Critical Care Department, King´s College Hospital NHS Trust Foundation. London, United Kingdom
- Corresponding author.
| | - JA Kraut
- Division of Nephrology and Department of Medicine Veterans Administration Greater Los Angeles Healthcare System and UCLA School Of Medicine, California, United States
| | - J Arévalo-Serrano
- Internal Medicine Department, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - SG Sakka
- Critical Care Department. Gemeinschaftsklinikum Mittelrhein gGmbH, Kemperhof und Ev, Stift St. Martin. Academic Teaching Hospital of the Johannes Gutenberg University Mainz. Germany
| | - C Harris
- Critical Care Department, King´s College Hospital NHS Trust Foundation. London, United Kingdom
| | - I Awad
- Critical Care Department, King´s College Hospital NHS Trust Foundation. London, United Kingdom
| | - M Toolan
- Critical Care Department, King´s College Hospital NHS Trust Foundation. London, United Kingdom
| | - S Vanapalli
- Critical Care Department, King´s College Hospital NHS Trust Foundation. London, United Kingdom
| | - A Collins
- Critical Care Department. Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, United Kingdom
| | - A Spataru
- Critical Care Department, King´s College Hospital NHS Trust Foundation. London, United Kingdom
| | - P Eiben
- Critical Care Department. Princess Royal University Hospital, King´s College Hospital NHS Trust Foundation, London, United Kingdom
| | - V Recea
- Critical Care Department, King´s College Hospital NHS Trust Foundation. London, United Kingdom
| | - C Brathwaite-Shirley
- Critical Care Department. Princess Royal University Hospital, King´s College Hospital NHS Trust Foundation, London, United Kingdom
| | - L Thompson
- Critical Care Department, King´s College Hospital NHS Trust Foundation. London, United Kingdom
| | - B Gurung
- Critical Care Department. Lewisham University Hospital, Lewisham and Greenwich NHS Trust, United Kingdom
| | - R Reece-Anthony
- Critical Care Department. Lewisham University Hospital, Lewisham and Greenwich NHS Trust, United Kingdom
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Abstract
Measurement of ventilation heterogeneity with the multiple-breath nitrogen washout (MBW) is usually performed using controlled breathing with a fixed tidal volume and breathing frequency. However, it is unclear whether controlled breathing alters the underlying ventilatory heterogeneity. We hypothesized that the width of the specific ventilation distribution (a measure of heterogeneity) would be greater in tests performed during free breathing compared with those performed using controlled breathing. Eight normal subjects (age range = 23-50 yr, 5 female/3 male) twice underwent MRI-based specific ventilation imaging consisting of five repeated cycles with the inspired gas switching between 21% and 100% O2 every ~2 min (total imaging time = ~20 min). In each session, tests were performed with free breathing (FB, no constraints) and controlled breathing (CB) at a respiratory rate of 12 breaths/min and no tidal volume control. The specific ventilation (SV) distribution in a mid-sagittal slice of the right lung was calculated, and the heterogeneity was calculated as the full width at half max of a Gaussian distribution fitted on a log scale (SV width). Free breathing resulted in a range of breathing frequencies from 8.7 to 15.9 breaths/min (mean = 11.5 ± 2.2, P = 0.62, compared with CB). Heterogeneity (SV width) was unchanged by controlled breathing (FB: 0.38 ± 0.12; CB: 0.34 ± 0.09, P = 0.18, repeated-measures ANOVA). The imposition of a controlled breathing frequency did not significantly affect the heterogeneity of ventilation in the normal lung, suggesting that MBW and specific ventilation imaging as typically performed provide an unperturbed measure of ventilatory heterogeneity.NEW & NOTEWORTHY By using MRI-based specific ventilation imaging (SVI), we showed that the heterogeneity of specific ventilation was not different comparing free breathing and breathing with the imposition of a fixed breathing frequency of 12 breaths/min. Thus, multiple-breath washout and SVI as typically performed provide an unperturbed measure of ventilatory heterogeneity.
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Affiliation(s)
- G Kim Prisk
- Department of Medicine, University of California, San Diego, California
| | | | - Eric T Geier
- Department of Medicine, University of California, San Diego, California
| | - Rui C Sá
- Department of Medicine, University of California, San Diego, California
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Wei SP, Stensel HD, Nguyen Quoc B, Stahl DA, Huang X, Lee PH, Winkler MKH. Flocs in disguise? High granule abundance found in continuous-flow activated sludge treatment plants. Water Res 2020; 179:115865. [PMID: 32388048 DOI: 10.1016/j.watres.2020.115865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
To date, high performance of full-scale aerobic granular sludge (AGS) technology has been demonstrated on a global scale. Its further integration with existing continuous flow activated sludge (CFAS) treatment plants is the next logical step. All granular sludge reactors operated in sequencing batch reactors (SBR) mode with anaerobic feeding conditions select for growth of phosphorus and glycogen accumulating organisms (PAO and GAO, respectively), which are known to enhance sludge settling characteristics. Therefore, we hypothesized that AGS are commonly present at full-scale CFAS processes with enhanced biological phosphorus removal (EBPR) and low sludge volume index (SVI). This hypothesis was confirmed at 13 EBPR plants, where granules were found present (at plants where SVI was lower than 100 ml/g) with a strong correlation between high granule abundance and low SVI. A wide range of granule abundance was found among the plants, ranging from 0.5% to as high as 80%. Evaluations of the EBPR plant process configurations showed that high granule abundances may be related to selector design features such as high anaerobic food to mass (F/M) ratios, unmixed in-line fermentation, and high influent soluble COD fraction. Granules were also observed at a non-EBPR plant with an aerobic selector receiving high F/M feeds. Quantitative PCR and 16S rRNA gene sequencing analyses revealed higher relative gene abundance of Accumulibacter PAO and Competibacter GAO in the granules over flocs, as well as a correlation between granule abundance and some possible EPS producers such as Flavobacterium and Competibacter. Our results indicated that process configurations that select for slow-growing or EPS-producing heterotrophs play an important role for granule formation in full-scale CFAS systems as previously shown in SBR configurations.
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Affiliation(s)
- Stephany P Wei
- University of Washington, Department of Civil & Environmental Engineering, 616 NE Northlake Place, Seattle, WA, 98195, USA.
| | - H David Stensel
- University of Washington, Department of Civil & Environmental Engineering, 616 NE Northlake Place, Seattle, WA, 98195, USA.
| | - Bao Nguyen Quoc
- University of Washington, Department of Civil & Environmental Engineering, 616 NE Northlake Place, Seattle, WA, 98195, USA.
| | - David A Stahl
- University of Washington, Department of Civil & Environmental Engineering, 616 NE Northlake Place, Seattle, WA, 98195, USA.
| | - Xiaowu Huang
- Hong Kong Polytechnic University, Department of Civil and Environmental Engineering, 11 Yuk Choi Rd, Hung Hom, Hong Kong.
| | - Po-Heng Lee
- Hong Kong Polytechnic University, Department of Civil and Environmental Engineering, 11 Yuk Choi Rd, Hung Hom, Hong Kong.
| | - Mari-K H Winkler
- University of Washington, Department of Civil & Environmental Engineering, 616 NE Northlake Place, Seattle, WA, 98195, USA.
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Mayer-Hirshfeld I, Agarwal GG, Jackson JS. SVI Self-Study Guide: A Study Tool for Independent Preparation for the AAMC Standardized Video Interview. MedEdPORTAL 2019; 15:10805. [PMID: 30931384 DOI: 10.15766/mep_2374-8265.10805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Since 2017, students applying to emergency medicine residencies must take the AAMC Standardized Video Interview (SVI) to assess their knowledge of professional behaviors and interpersonal and communication skills. Due to the SVI's novelty, there are not many study tools available to prepare for it, outside of the resources provided by the AAMC. Methods The SVI Self-Study Guide is a PowerPoint document that learners can use to prepare for the SVI independently. It is intended for fourth-year medical students who are applying to emergency medicine residencies and therefore planning to take the SVI. The guide was distributed via email and assessed with a pre- and postquiz measuring subjective feelings of preparedness as well as testing knowledge of professionalism and interpersonal and communication skills. Results Eleven students were invited to use the SVI Self-Study Guide, of whom 10 and eight took the pre- and postquiz, respectively. There was a statistically significant increase in learners' self-rated feelings of preparedness to take the SVI (p < .05). Although there was no significant change in the average score on four knowledge-based questions (p = .29), the average score increased from 72.50% to 93.25%. Discussion Overall, there was a higher improvement in feelings of preparedness to take the SVI than in performance on knowledge-based questions. This suggests that learners benefited the most from practicing using the SVI testing format. The SVI Self-Study Guide can be distributed via email to supplement existing resources in preparing for the SVI.
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Jahn L, Svardal K, Krampe J. Comparison of aerobic granulation in SBR and continuous-flow plants. J Environ Manage 2019; 231:953-961. [PMID: 30602256 DOI: 10.1016/j.jenvman.2018.10.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/21/2018] [Accepted: 10/28/2018] [Indexed: 06/09/2023]
Abstract
Up to now, aerobic granulation of activated sludge is only realised in SBRs, where the discontinuous feed and sedimentation allow the formation of dense granules with excellent settling properties. However, aerobic granulation in continuous-flow plants (CFP) is gaining more and more interest in order to exploit the advantages of these excellent sludge properties to construct compact and efficient WWTP. Within the scope of this project, a SBR and CFP were operated in parallel to investigate the aerobic granulation of activated sludge and to compare the biomass in terms of their structure and settling behavior. CFP operation included two experimental phases with different reactor designs. The use of synthetic wastewater during phase I led to a biomass with a SVI of 42 ml g-1, whereby the SVI declined only to 85 ml g-1 in the second phase and the use of municipal sewage. After the start-up period, microscopic images of the biomass from CFP comprised small compact granules with a high flocculent fraction. Particle size distribution for phase II confirm, that 72% of the particles had a size over 200 μm. A strong correlation was observed between the appearance of NOx-N in the first reactor and the SVI. The results illustrate, that the anaerobic conditions during feeding are essential to keep stable granules.
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Affiliation(s)
- L Jahn
- Institute for Water Quality and Resource Management, TU Wien, Karlsplatz 13/226-1, 1040, Vienna, Austria.
| | - K Svardal
- Institute for Water Quality and Resource Management, TU Wien, Karlsplatz 13/226-1, 1040, Vienna, Austria
| | - J Krampe
- Institute for Water Quality and Resource Management, TU Wien, Karlsplatz 13/226-1, 1040, Vienna, Austria
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Karnes RJ, Bergstralh EJ, Davicioni E, Ghadessi M, Buerki C, Mitra AP, Crisan A, Erho N, Vergara IA, Lam LL, Carlson R, Thompson DJS, Haddad Z, Zimmermann B, Sierocinski T, Triche TJ, Kollmeyer T, Ballman KV, Black PC, Klee GG, Jenkins RB. Validation of a genomic classifier that predicts metastasis following radical prostatectomy in an at risk patient population. J Urol 2013; 190:2047-53. [PMID: 23770138 PMCID: PMC4097302 DOI: 10.1016/j.juro.2013.06.017] [Citation(s) in RCA: 238] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2013] [Indexed: 01/17/2023]
Abstract
PURPOSE Patients with locally advanced prostate cancer after radical prostatectomy are candidates for secondary therapy. However, this higher risk population is heterogeneous. Many cases do not metastasize even when conservatively managed. Given the limited specificity of pathological features to predict metastasis, newer risk prediction models are needed. We report a validation study of a genomic classifier that predicts metastasis after radical prostatectomy in a high risk population. MATERIALS AND METHODS A case-cohort design was used to sample 1,010 patients after radical prostatectomy at high risk for recurrence who were treated from 2000 to 2006. Patients had preoperative prostate specific antigen greater than 20 ng/ml, Gleason 8 or greater, pT3b or a Mayo Clinic nomogram score of 10 or greater. Patients with metastasis at diagnosis or any prior treatment for prostate cancer were excluded from analysis. A 20% random sampling created a subcohort that included all patients with metastasis. We generated 22-marker genomic classifier scores for 219 patients with available genomic data. ROC and decision curves, competing risk and weighted regression models were used to assess genomic classifier performance. RESULTS The genomic classifier AUC was 0.79 for predicting 5-year metastasis after radical prostatectomy. Decision curves showed that the genomic classifier net benefit exceeded that of clinical only models. The genomic classifier was the predominant predictor of metastasis on multivariable analysis. The cumulative incidence of metastasis 5 years after radical prostatectomy was 2.4%, 6.0% and 22.5% in patients with low (60%), intermediate (21%) and high (19%) genomic classifier scores, respectively (p<0.001). CONCLUSIONS Results indicate that genomic information from the primary tumor can identify patients with adverse pathological features who are most at risk for metastasis and potentially lethal prostate cancer.
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Rahman S, Leesar T, Cilingiroglu M, Effat M, Arif I, Helmy T, Leesar MA. Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions: a serial volumetric intravascular ultrasound study. JACC Cardiovasc Interv 2013; 6:923-31. [PMID: 23954062 DOI: 10.1016/j.jcin.2013.04.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/12/2013] [Accepted: 04/25/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intravascular ultrasound (IVUS) was performed to investigate the impact of kissing balloon inflation (KBI) on the main vessel (MV) stent volume, area, and symmetry after side-branch (SB) dilation in patients with coronary bifurcation lesions (CBL). BACKGROUND It remains controversial whether KBI would restore the MV stent area and symmetry loss after SB dilation. METHODS A total of 88 serial IVUS examinations of the MV were performed after MV angioplasty, MV stenting, SB dilation, and KBI in 22 patients with CBL. The MV stent was divided into proximal, bifurcation, and distal segments; the stent volume index (SVI), minimal stent area (MSA), stent symmetry index (SSI), and external elastic membrane (EEM) volume index were measured in 198 stent segments and compared after MV stenting, SB dilation, and KBI. RESULTS In the bifurcation segment, SVI, MSA, and SSI were significantly smaller after SB dilation than after MV stenting and KBI (SVI was 6.10 ± 1.50 mm(3)/mm vs. 6.68 ± 1.60 mm(3)/mm and 6.57 ± 1.60 mm(3)/mm, respectively, p < 0.05; MSA was 5.15 ± 1.30 mm(2) vs. 6.08 ± 1.40 mm(2) and 5.86 ± 1.50 mm(2), respectively, p < 0.05; and SSI was 0.78 ± 0.02 mm(2) vs. 0.87 ± 0.03 mm(2) and 0.84 ± 0.03 mm(2), respectively, p < 0.05). KBI restored the MV SVI, MSA, and SSI after SB dilation. In the proximal segment, SVI, MSA, and EEM volume index were significantly larger, but SSI was smaller after KBI than after MV stenting and SB dilation. In the distal segment, neither SB dilation nor KBI had a significant impact on the MV stent volume or symmetry. CONCLUSIONS This is the first comprehensive volumetric IVUS analysis of CBL, to our knowledge, demonstrating that KBI restores the MV stent volume, area, and symmetry loss after SB dilation in the bifurcation segment, and induces asymmetric stent expansion in the proximal segment.
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Affiliation(s)
- Shahid Rahman
- Division of Cardiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Sihota NJ, Mayer KU, Toso MA, Atwater JF. Methane emissions and contaminant degradation rates at sites affected by accidental releases of denatured fuel-grade ethanol. J Contam Hydrol 2013; 151:1-15. [PMID: 23685780 DOI: 10.1016/j.jconhyd.2013.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 03/23/2013] [Accepted: 03/27/2013] [Indexed: 06/02/2023]
Abstract
The recent increase in the use of denatured fuel-grade ethanol (DFE) has enhanced the probability of its environmental release. Due to the highly labile nature of ethanol (EtOH), it is expected to rapidly biodegrade, increasing the potential for inducing methanogenic conditions in the subsurface. As environmental releases of DFE can be expected to occur at the ground surface or in the vadose zone (e.g., due to surficial spills from rail lines or tanker trucks and leaking underground storage tanks), the potential for methane (CH4) generation at DFE spill sites requires evaluation. An assessment is needed because high CH4 generation rates may lead to CH4 fluxes towards the ground surface, which is of particular concern if spills are located close to human habitation-related to concerns of soil vapor intrusion (SVI). This work demonstrates, for the first time, the measurement of surficial gas release rates at large volume DFE spill sites. Two study sites, near Cambria and Balaton, in MN are investigated. Total carbon emissions at the ground surface (summing carbon dioxide (CO2) and CH4 emissions) are used to quantify depth-integrated DFE degradation rates. Results from both sites demonstrate that substantial CO2 and CH4 emissions do occur-even years after a spill. However, large total carbon fluxes, and CH4 emissions in particular, were restricted to a localized area within the DFE source zone. At the Balaton site, estimates of total DFE carbon losses in the source zone ranged between 5 and 174 μmol m(-2) s(-1), and CH4 effluxes ranged between non-detect and 9 μmol m(-2) s(-1). At the Cambria site estimates of total DFE carbon losses in the source zone ranged between 8 and 500 μmol m(-2) s(-1), and CH4 effluxes ranged between non-detect and 393 μmol m(-2) s(-1). Substantial CH4 accumulation, coupled with oxygen (O2) depletion, measured in samples collected from custom-designed gas collection chambers at the Cambria site suggests that the development of explosion or asphyxiation hazards is possible in confined spaces above a rapidly degrading DFE release. However, the results also indicate that the development of such hazards is locally constrained, will require a high degree of soil moisture, close proximity to the source zone, a good connection between the soil and the confined space, and poorly aerated conditions.
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Affiliation(s)
- Natasha J Sihota
- University of British Columbia, Dept. of Earth and Ocean Sciences, 6339 Stores Rd., Vancouver, B.C., Canada V6T 1Z4.
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Jeong IG, Lim JH, You D, Kim MH, Choi HJ, Kim JK, Cho KS, Hong JH, Ahn H, Kim CS. Incremental value of magnetic resonance imaging for clinically high risk prostate cancer in 922 radical prostatectomies. J Urol 2013; 190:2054-60. [PMID: 23791890 DOI: 10.1016/j.juro.2013.06.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2013] [Indexed: 01/19/2023]
Abstract
PURPOSE We investigated the incremental value of magnetic resonance imaging in addition to clinical variables for predicting pathological outcomes and disease recurrence in patients with clinically high risk prostate cancer. MATERIALS AND METHODS A total of 922 consecutive patients with clinically high risk prostate cancer underwent magnetic resonance imaging before radical prostatectomy. We created multivariate logistic regression and Cox proportional hazards models with clinical variables only or combined with magnetic resonance imaging data to predict pathological outcomes and biochemical recurrence. The models were compared using ROC curves and the Harrell concordance index. RESULTS The proportion of patients with pathological extracapsular extension, seminal vesicle invasion and lymph node metastasis was 57.5%, 12.7% and 6.3%, respectively. The sensitivity and specificity of extracapsular extension, seminal vesicle invasion and lymph node metastasis detection were 43% and 84.2%, 34.9% and 93.8%, and 14.0% and 96.9%, respectively. The area under the ROC curve of the model with clinical variable and magnetic resonance imaging data was greater than that of the model with clinical variables alone to predict extracapsular extension and seminal vesicle invasion (0.734 vs 0.697, p=0.001 and 0.750 vs 0.698, p<0.001, respectively). The 5-year biochemical recurrence-free survival rate was 56.1%. To predict biochemical recurrence the concordance index of the multivariate model with clinical variables only and with clinical variables plus magnetic resonance imaging data was 0.563 and 0.599, respectively (p=0.003). CONCLUSIONS Magnetic resonance imaging findings have incremental value in addition to clinical variables for predicting pathological outcomes and disease recurrence.
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Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C, Klein E, Michalski J, Roach M, Sartor O, Wolf JS, Faraday MM. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol 2013; 190:441-9. [PMID: 23707439 DOI: 10.1016/j.juro.2013.05.032] [Citation(s) in RCA: 285] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this guideline is to provide a clinical framework for the use of radiotherapy after radical prostatectomy as adjuvant or salvage therapy. MATERIALS AND METHODS A systematic literature review using the PubMed®, Embase, and Cochrane databases was conducted to identify peer-reviewed publications relevant to the use of radiotherapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed. RESULTS Guideline statements are provided for patient counseling, the use of radiotherapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a re-staging evaluation. CONCLUSIONS Physicians should offer adjuvant radiotherapy to patients with adverse pathologic findings at prostatectomy (i.e., seminal vesicle invasion, positive surgical margins, extraprostatic extension) and should offer salvage radiotherapy to patients with prostatic specific antigen or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiotherapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiotherapy as well as the potential benefits of preventing recurrence. The decision to administer radiotherapy should be made by the patient and the multi-disciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status. Please visit the ASTRO and AUA websites (http://www.redjournal.org/webfiles/images/journals/rob/RAP%20Guideline.pdf and http://www.auanet.org/education/guidelines/radiation-after-prostatectomy.cfm) to view this guideline in its entirety, including the full literature review.
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Affiliation(s)
- Ian M Thompson
- American Urological Association Education and Research, Inc., Linthicum, Maryland, USA
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Ploussard G, Staerman F, Pierrevelcin J, Saad R, Beauval JB, Roupret M, Audenet F, Peyromaure M, Delongchamps NB, Vincendeau S, Fardoun T, Rigaud J, Villers A, Bastide C, Soulie M, Salomon L; Committee of Cancerology of the Association of French Urology. Predictive factors of oncologic outcomes in patients who do not achieve undetectable prostate specific antigen after radical prostatectomy. J Urol. 2013;190:1750-1756. [PMID: 23643600 DOI: 10.1016/j.juro.2013.04.073] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE We identified factors predicting oncologic outcomes in cases of persistently detectable prostate specific antigen. MATERIALS AND METHODS We reviewed the charts of patients treated with radical prostatectomy between 1998 and 2011 at a total of 14 centers. Study inclusion criteria were radical prostatectomy for presumed localized prostate cancer, absent positive nodes and detectable prostate specific antigen, defined as prostate specific antigen 0.1 ng/ml or greater 6 weeks postoperatively. Of the 9,735 radical prostatectomy cases reviewed 496 (5.1%) were eligible for analysis. Predictive factors for oncologic outcomes were assessed in time dependent analyses using the Kaplan-Meier method and Cox regression models. RESULTS At 6 weeks prostate specific antigen was 0.1 to 6.8 ng/ml. Biochemical progression was noted in 74.4% of patients and clinical metastasis was noted in 5%. The 2 most powerful predictors of general salvage treatment (vs radiotherapy) were postoperative prostate specific antigen greater than 1 ng/ml (OR 3.46, p=0.032) and prostate specific antigen velocity greater than 0.2 ng/ml per year (HR 6.01, p=0.001). Positive prostate specific antigen velocity was the single factor that independently correlated with the risk of failed salvage therapy (HR 2.6, p=0.001). The 5-year disease-free survival rate was 81.0% in patients with stable or negative prostate specific antigen velocity compared with 58.4% in those with positive prostate specific antigen velocity (p<0.001). CONCLUSIONS Patients with detectable prostate specific antigen after radical prostatectomy have a poor biochemical outcome. We identified postoperative prostate specific antigen and prostate specific antigen velocity as independent predictors of progression and failed salvage treatment. In addition to pathological prognostic factors, these factors should be considered early to better stratify patients for adjuvant therapy.
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