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Previous studies have demonstrated possible differences in glioblastoma (GBM) survival attributable to ethnicity. The goal of this study was to quantify oncogenic differences and evaluate the overall survival (OS) and progression-free survival (PFS) differences in GBM patients across race/ethnicity using both population-based surveillance and institutional data sets from the United States (US) and Mexico. Retrospective cohort study comprising the Texas Cancer Registry (TCR, n = 4134) and referral institutions located in US (n = 254) and Mexico (n = 47) were evaluated. Primary outcomes include OS and PFS. Oncogenic differences attributable to ethnicity were assessed. IDH1/IDH2 status was evaluated by sequencing in US and Mexico samples. Kaplan-Meier and Cox proportional hazards regression for survival analysis. A total of 4134 GBM patients were identified from the TCR data set, ethnicity comparison demonstrated that Hispanic patients were diagnosed at a significantly younger age compared to non-Hispanic white patients (NHW) (median: 58 vs. 62, P < 0.001) and had improved OS (hazard ratio: 0.82, P < 0.001). In the oncogenic analysis, we observed a significant enrichment of IDH1/IDH2 mutations in Mexican Hispanic patients compared to US Hispanic patients (29.8% vs. 7.9%, P = 0.012); IDH2 mutations drove this difference. Post-progression survival was significantly shorter in patients from Mexico than US (3.0 vs. 11.4 months; P < 0.001), while OS remained similar. IDH2 mutations are more prevalent in Mexican Hispanic individuals compared to US individuals and may be a crucial contributor to the previously reported survival benefit of Hispanic individuals in large population databases. These findings are critical for both screening of IDH2 mutations and targeted interventions in GBM. [ABSTRACT FROM AUTHOR]

Conversational agents (CAs) are an integral component of many personal and business interactions. Many recent advancements in CA technology have attempted to make these interactions more natural and human-like. However, it is currently unclear how human-like traits in a CA impact the way users respond to questions from the CA. In some applications where CAs may be used, detecting deception is important. Design elements that make CA interactions more human-like may induce undesired strategic behaviors from human deceivers to mask their deception. To better understand this interaction, this research investigates the effect of conversational skill—that is, the ability of the CA to mimic human conversation—from CAs on behavioral indicators of deception. Our results show that cues of deception vary depending on CA conversational skill, and that increased conversational skill leads to users engaging in strategic behaviors that are detrimental to deception detection. This finding suggests that for applications in which it is desirable to detect when individuals are lying, the pursuit of more human-like interactions may be counter-productive. • People type differently when conversing with conversational agents that have more human-like conversational skill. • People show strategic behavior to conceal their deception when conversing with a more human-like conversational agent. • Conversational agents that indicate understanding affect behavior more than agents that merely have variety in responses. [ABSTRACT FROM AUTHOR]

Autoimmune diseases, such as celiac disease, multiple sclerosis, and type 1 diabetes, are leading causes of morbidity and mortality in the United States. In these disease states, immune regulatory mechanisms fail that result in T and B cell-mediated destruction of self-tissues. The known role of T cells in mediating autoimmune diseases has led to the emergence of numerous therapies aimed at inactivating T cells, however successful 'tolerance-inducing' strategies have not yet emerged for approved standard-of-care clinical use. In this review, we describe relevant examples of antigen-specific tolerance approaches that have been applied in clinical trials for human diseases. Furthermore, we describe the evolution of biomaterial approaches from cell-based therapies to induce immune tolerance with a focus on the Tolerogenic Immune-Modifying nanoParticle (TIMP) platform. The TIMP platform can be designed to treat various autoimmune conditions and is currently in clinical trials testing its ability to reverse celiac disease. [ABSTRACT FROM AUTHOR]

Introduction: Despite increasing rates of opioid misuse and hospitalizations, rates of treatment for those with opioid use disorder (OUD) are very low. This study examined the impact of the Patient Protection and Affordable Care Act's (ACA) insurance expansion on improving rates of insurance, health care access, and treatment for those with OUD.Methods: Data on individuals ages 18-64 with OUD come from the 2008-2014 National Survey on Drug Use and Health (N=4100). Multivariable logistic regression analyses were performed to estimate the trends of health care insurance, treatment and barriers to care across the stages of ACA implementation: pre-ACA (2008-2009), partial-ACA (2010-2013), and national implementation (2014). All models were adjusted for predisposing, enabling, and need factors.Results: In both adjusted and unadjusted comparisons, national implementation of the ACA was associated with significant improvements in outcome measures for those with OUD. Multivariable analyses indicate that, after national implementation, those with OUD were significantly less likely to be uninsured and were less likely to report financial barriers as a reason for not receiving substance use treatment, relative to the pre-ACA period. Individuals were also more likely to receive substance use treatment and were more likely to report that insurance paid for treatment after national implementation of the ACA relative to the pre-ACA period. These results persisted when national implementation was compared relative to partial-implementation.Conclusions: National implementation of the ACA has helped to reduce rates of uninsurance, barriers to care, and improve rates of substance use treatment for those with OUD. [ABSTRACT FROM AUTHOR]

Background: Research has documented significant associations between life stress, especially interpersonal stress, and suicidal ideation in adolescents. Little is known about variables that explain the association between interpersonal stress and suicidal ideation.Methods: The present study evaluated a conceptual model in which interpersonal stress (chronic and episodic) predicted suicidal ideation indirectly via thwarted belongingness and perceived burdensomeness among 180 inpatients (65.0% girls) ages 12-17 years (M=14.72, SD=1.49). Non-interpersonal stress was also examined to determine whether the model was specific to interpersonal stress or common to stress in general.Results: Structural equation modeling identified a significant indirect effect of chronic interpersonal stress on suicidal ideation via perceived burdensomeness. Episodic interpersonal stress was significantly correlated with thwarted belongingness and suicidal ideation, but was not a significant predictor of suicidal ideation in a model that controlled for depressive and anxious symptoms. No significant associations were found between non-interpersonal stress and suicidal ideation.Limitations: Adolescents were the sole informant source, data on psychiatric diagnoses were not available, and the optimal time interval for examining stress remains unclear. The cross-sectional study design prevents conclusions regarding directionality.Conclusions: These findings highlight the role of chronic interpersonal stress in suicidal ideation in adolescents, as well as the potential promise of perceived burdensomeness as a target for programs designed to prevent or reduce suicidal ideation. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence and predictors of potentially inappropriate anticholinergic medication use in older adults with dementia.Design: A cross-sectional study.Setting: United States, 2009-2010.Participants: Medical Expenditure Panel Survey household component participants aged 65 years or older identified as having dementia and using potentially inappropriate anticholinergic medication.Main Outcome Measures: Prevalence and predictors of potentially inappropriate anticholinergic medication use as per the updated 2012 American Geriatrics Society Beers criteria.Results: A total of 3.78 million older adult patients (95% confidence interval [CI] 3.17 million to 4.38 million) were identified as having dementia, for an overall prevalence of 4.81%. Of those patients, an estimated 1.02 million (95% CI 0.70 million to 1.30 million) were reported to use potentially inappropriate anticholinergic medications, for an overall prevalence of 26.95% (95% CI 20.10% to 33.79%). The most frequently prescribed drugs were oxybutynin, solifenacin, paroxetine, tolterodine, promethazine, and cyclobenzaprine. Multivariable logistic analysis revealed that those patients with the need characteristics of self-reported anxiety, mood disorders, and "fair/poor" general health status had increased odds of potentially inappropriate anticholinergic use, while patients with the predisposing characteristic of being aged 75-84 years had decreased odds of potentially inappropriate anticholinergic use.Conclusion: More than one in four older adults with dementia were found to use potentially inappropriate anticholinergics. Given the adverse cognitive effects of these medications, there is a strong need to monitor and optimize their use in older adult patients with dementia. [ABSTRACT FROM AUTHOR]

Several empirical studies have estimated a negative relationship between the share of an area's elderly population and per-pupil education spending. These findings have often been interpreted as evidence that an aging population has hindered the growth in per-pupil expenditures. We offer a reinterpretation of these oft-cited estimates and demonstrate that the population has aged in a way not reflected in these earlier studies’ empirical designs. After fully accounting for actual U.S. population trends, we demonstrate that a rise in the elderly share of the population has resulted in a rise in per-pupil education spending, not a decline. [ABSTRACT FROM AUTHOR]

• Compared SCO 2 TPRO to the FE/NETL CO 2 Saline Storage Cost Model (CSSC). • SCO 2 TPRO and CSSC use fundamentally different methods to estimate cost and capacity. • CSSC cost estimates are several times higher than SCO 2 TPRO cost estimates. • CSSC capacity estimates are about twice as high as SCO 2 TPRO capacity estimates. • SCO 2 TPRO can provide estimates thousands of times faster than CSSC. Meeting greenhouse gas emission reduction targets will likely require identifying and assessing subsurface storage space for sequestering billions of tonnes of CO 2 each year. Accomplishing this feat could include estimating the cost and capacity for thousands to hundreds-of-thousands of potential geologic CO 2 storage sites with CO 2 storage screening tools. In this study, we introduce a screening tool, SCO 2 TPRO, and compare and contrast it to the FE/NETL CO 2 Saline Storage Cost model (CSSC) using publicly available databases of saline reservoir properties in the United States. We find that the two tools use different methodologies to execute site-screening: SCO 2 TPRO calculates dynamic CO 2 injection rates and plume evolution that are used to estimate operationally-realistic well spacing designs and CO 2 storage capacities, whereas CSSC combines a volumetric storage estimation approach with geology-engineering well injectivity equations that can lead to an unrealistically high number of wells. These methodological differences translate into CSSC cost estimates that are several times higher than the SCO 2 TPRO estimates and around double for the capacity estimates. SCO 2 TPRO can also screen thousands of potential storage sites in seconds, which is thousands of times faster than CSSC. Lastly, we also find there is no single publicly available dataset of saline formation properties that can be used for screening across the United States. [ABSTRACT FROM AUTHOR]

Abstract: Context: Debates persist about the relevance of “dignity” as an ethical concept in U.S. health care, especially in end-of-life care. Objectives: To describe the attitudes and beliefs regarding the usefulness and meaning of the concept of dignity and to examine judgments about a clinical scenario in which dignity might be relevant. Methods: Two thousand practicing U.S. physicians, from all specialties, were mailed a survey. Main measures included physicians'' judgments about an end-of-life clinical scenario (criterion variable), attitudes about the concept of dignity (predictors), and their religious characteristics (predictors). Results: Responses were received from 1032 eligible physicians (54%). Nine (90%) of 10 physicians reported that dignity was relevant to their practice. After controlling for age, gender, region, and specialty, physicians who judged that the case patient had either some dignity or full dignity, and who agreed that dignity is given by a creator, were all positively associated with believing that the patient''s life was worth living (odds ratio [OR] 10.2, 95% confidence interval [CI] 5.8–17.8, OR 20.5, 95% CI 11.4–36.8, OR 4.7, 95% CI 3.1–7.0, respectively). Respondents who strongly agreed that “all living humans have the same amount of dignity” were also more likely to believe that the patient''s life was worth living (OR 1.8, 95% CI 1.2–2.7). Religious characteristics also were associated with believing that the case patient''s life was worth living (OR 4.1, 95% CI 2.4–7.2, OR 3.2, 95% CI 1.6–6.3, OR 9.2, 95% CI 4.3–19.5, respectively). Conclusion: U.S. physicians view the concept of dignity as useful. Those views are associated with their judgments about common end-of-life scenarios in which dignity concepts may be relevant. [Copyright &y& Elsevier]

Abstract: In this paper, we explore the potential implications of geographical variability for the structure of social networks. Beginning with some basic simplifying assumptions, we derive a number of ways in which local network structure should be expected to vary across a region whose population is unevenly distributed. To examine the manner in which these effects would be expected to manifest given realistic population distributions, we then perform an exploratory simulation study that examines the features of large-scale interpersonal networks generated using block-level data from the 2000 U.S. Census. Using a stratified sample of micropolitan and metropolitan areas with populations ranging from approximately 1000 to 1,000,000 persons, we extrapolatively simulate network structure using spatial network models calibrated to two fairly proximate social relations. From this sample of simulated networks, we examine the effect of both within-location and between-location heterogeneity on a variety of structural properties. As we demonstrate, geographical variability produces large and distinctive features in the “social fabric” that overlies it; at the same time, however, many aggregate network properties can be fairly well-predicted from relatively simple spatial demographic variables. The impact of geographical variability is thus predicted to depend substantially on the type of network property being assessed, and on the spatial scale involved. [ABSTRACT FROM AUTHOR]

Abstract: Background: On January 12, 2010, Haiti experienced the western hemisphere''s worst-ever natural disaster. Within 24 hours, the United States Naval Ship Comfort received orders to respond, and a group of more than 500 physicians, nurses, and staff undertook the largest and most rapid triage and treatment since the inception of hospital ships. Methods: These data represent pediatric surgical patients treated aboard the United States Naval Ship Comfort between January 19 and February 27, 2010. Prospective databases managed by patient administration, radiology, blood bank, laboratory services, and surgical services were combined to create an overall patient care database that was retrospectively reviewed for this analysis. Results: Two hundred thirty-seven pediatric surgical patients were treated, representing 27% of the total patient population. These patients underwent a total of 213 operations composed of 243 unique procedures. Orthopedic procedures represented 71% of the total caseload. Patients returned to the operating room up to 11 times and required up to 28 days for completion of surgical management. Conclusions: This represents the largest cohort of pediatric surgical patients in an earthquake response. Our analysis provides a model for anticipating surgical caseload, injury patterns, and duration of surgical course in preparing for future disaster response missions. Moreover, we propose a 3-phased response to disaster medicine that has not been previously described. [Copyright &y& Elsevier]

Objective: To examine the impact of supply and demand factors on filled positions for pharmacists and pharmacist extenders (pharmacist technicians and aides) and assess differences across states through analysis of state-level pharmacist labor market data.Design: Cross-sectional analysis.Setting: United States.Participants: Not applicable.Interventions: Not applicable.Main Outcome Measures: State-level counts of filled pharmacist and pharmacist-extender positions, wages, and various available demographic, health, policy, and other factors related to the pharmacist labor market.Results: Across states, the total population and the number of community pharmacy prescriptions were very accurate predictors (R2 = 0.99) of the number of pharmacist and pharmacist-extender positions, and all other variables were insignificant after these two variables were controlled for. Pharmacists and pharmacist-extenders were positively correlated, and the ratio of the two was not related to observable policy-related variables. Outlying states, in terms of simple pharmacist-to-population ratios, were difficult to categorize.Conclusion: Future changes in prescriptions are likely to affect the pharmacist and pharmacist-extender labor markets. Across states, pharmacists and extenders relate as complements rather than substitutes. The number of pharmacist graduates and state-level regulations regarding technician-to-pharmacist ratios appears to have a small effect on filled positions across states. [ABSTRACT FROM AUTHOR]

Background: Oropharyngeal squamous cell carcinoma (OPSCC) has now surpassed cervical cancer as the most common site of HPV-related cancer in the United States. HPV-positive OPSCCs behave differently from HPV-negative tumors and often present with early lymph node involvement. The bacterial microbiome of HPV-associated OPSCC may contribute to carcinogenesis, and certain bacteria may influence the spread of cancer from the primary site to regional lymphatics.Objective: To determine the bacterial microbiome in patients with HPV-associated, early tonsil SCC and compare them to benign tonsil specimens.Method: The microbiome of primary tumor specimens and lymph nodes was compared to benign tonsillectomy specimens with pan-pathogen microarray (PathoChip).Results: A total of 114 patients were enrolled in the study. Patients with OPSCC had a microbiome that shifted towards more gram-negative. Numerous signatures of bacterial family and species were associated with the primary tumors and lymph nodes of cancer patients, including the urogenital pathogens Proteus mirabilis and Chlamydia trachomatis, Neisseria gonorrhoeae, Shigella dysenteriae, and Orientia tsutsugamushi.Conclusion: Our results suggest that detection of urogenital pathogens is associated with lymph node metastasis for patients with HPV-positive OPSCCs. Additional studies are necessary to determine the effects of the OPSCC microbiome on disease progression and clinical outcomes. [ABSTRACT FROM AUTHOR]

• About 33 million tonnes of dry-weight urban wood are available in the U.S. annually due to tree mortality. • About 28 million tonnes of dry-weight urban tree leaf litter in the U.S. is produced annually. • Potential annual value from U.S. urban tree wood waste ranges between $89 and $786 million, depending upon products created. • Potential nutrient value from U.S. annual urban tree leaf litter is $551 million. Urban trees provide numerous benefits to society, but upon removal, this resource is underutilized and often considered a waste product to be discarded. However, urban trees have a potential to be utilized for various products, create jobs and an income stream for cities. The latest data on urban forests in the United States were used to estimate the potential annual value that could be derived from urban tree waste. Assuming a mortality rate of 2%, annual urban woody biomass loss in the U.S. equates to about 46 million tonnes of fresh-weight merchantable wood or 7.2 billion board feet of lumber or 16 million cords of firewood. The potential annual value from urban wood waste ranges between $89-786 million depending upon the product derived (e.g., wood chips to lumber). States with the greatest urban wood product potential are Florida ($6.6–57.6 million/year) and Georgia ($6.0–52.7 million/year). Along with woody biomass, annual leaf loss has a potential to produce value. The value of nutrients in annual leaf litter is estimated at $551 million per year. In addition to direct revenue from sales, other environmental benefits can be derived through tree waste utilization that reduces landfill waste, use of fertilizers and fossil fuel use in energy production. There are various reasons why this potential maximum value from urban tree waste is not and likely cannot be attained, but its current use and value can be increased. Creating markets and systems to utilize urban tree removals and leaves can help enhance income for urban forest management as well as create social and environmental goods. [ABSTRACT FROM AUTHOR]

The use of potentially inappropriate medications (PIMs) is considered an important quality indicator for older adults seen in the ambulatory care setting. To evaluate the pattern of potentially inappropriate medication (PIMs) use as specified in the Beers Criteria, for older adults during emergency department (ED) visits in the United States. Using data from the National Hospital Ambulatory Care Survey (NHAMCS) we identified older adults (age 65 or older) discharged home from an ED visit in 2019. We defined PIMs as those with an 'avoid' recommendation under the American Geriatrics Society (AGS) 2019 Beers Criteria in older adults. Logistic regression models were used to assess demographic, clinical, and hospital factors associated with the use of any PIMs upon ED discharge. Overall, 5.9% of visits by older adults discharged from the ED included administration or prescriptions for PIMs. Among those who received any PIMs, 25.5% received benzodiazepines, 42.5 % received anticholinergics, 1.4% received nonbenzodiazepine hypnotics, and 0.5% received barbiturates. A multivariable model showed statistically significant associations for age 65 to 74 (OR 1.91, 95% CI 1.39–2.62 vs. age >=75), dementia (OR 0.45, 95% CI 0.21–0.95), lower immediacy (OR 2.45, 95% CI 1.56–3.84 vs. higher immediacy), and Northeastern rural region (OR 0.34, 95% CI 0.21–0.55 vs. Midwestern rural). We found that younger age and lower immediacy were associated with increased prescriptions of PIMs for older adults seen, while dementia and Northeastern rural region was associated with reduced use of PIMs seen and discharged from EDs in United States. [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma is the third leading cause of cancer-related death in the United States. As one of the most lethal cancer types, the prognosis for patients diagnosed with pancreatic cancer remains dismal and novel investigations are urgently needed. Evidence for an association of microbes with pancreatic cancer risk, development, treatment response, and post-treatment survivorship is rapidly developing. Herein, we provide an overview on the role of the microbiome as it relates to the natural history of pancreatic cancer, including host immune interactions, alterations in metabolism, direct carcinogenic effect, and its role in treatment response. [ABSTRACT FROM AUTHOR]

Background The risk of sport-related concussion (SRC) has emerged as a major public health concern. In rare instances, sport-related head injuries can be even more severe, such as subdural hemorrhage, epidural hemorrhage, or malignant cerebral edema. Unlike SRCs, sport-related structural brain injury (SRSBI) is rare, may require neurosurgical intervention, and can lead to permanent neurologic deficit or death. Data characterizing SRSBI are limited, and many have recognized the need to better understand these catastrophic brain injuries. The goal of the current series is to describe, in detail, the presentation, management, and outcomes of examples of these rare injuries. Case Description During the fall of 2015, three high school football players presented with acute subdural hemorrhages following in-game collisions and were treated at our institution within a span of 2 months. For the 2 athletes who required surgical intervention, a previous SRC was sustained within 4 weeks before the catastrophic event. One year after injury, 2 players have returned to school, though with persistent deficits. One patient remains nonverbal and wheelchair bound. None of the athletes has returned to sports. Conclusions Acute subdural hemorrhage resultant from an in-game football collision is rare. The temporal proximity of the reported SRSBIs to recent SRCs emphasizes the importance of return-to-play protocols and raises questions regarding the possibility of second impact syndrome. Although epidemiologic conclusions cannot be drawn from this small sample, these cases provide a unique opportunity to demonstrate the presentation, management, and long-term outcomes of SRSBI in American high school football. [ABSTRACT FROM AUTHOR]

Osteoporosis is a burgeoning public health problem for over 44 million people in the United States. The magnetic resonance imaging-based vertebral bone quality (VBQ) score and cervical VBQ (C-VBQ) score are two novel approaches that use data routinely gathered during preoperative evaluation to assess bone quality. The goal of this study was to investigate the relationship between the VBQ and C-VBQ scores. We performed a retrospective review of chart data for patients who underwent spine surgery for degenerative conditions between 2015 and 2022. Patients eligible for study inclusion had preoperative T1-weighted magnetic resonance imaging of the lumbar and cervical spine available for review. Demographics of each patient were collected. The VBQ score was determined by dividing the median signal intensity (SI) of the L1-L4 vertebral bodies by the SI of the cerebrospinal fluid at L3. The C-VBQ score was calculated by dividing the median SI of the C3-C6 vertebral bodies by the SI of the C2 cerebrospinal fluid space. Pearson's correlation test was utilized to evaluate the association between the scores. We identified 171 patients, with a mean age of 57.44 ± 11.79 years. The interrater reliability of the VBQ and C-VBQ measurements was excellent (intraclass correlation-coefficients were 0.89 and 0.84, respectively). A statistically significant, positive correlation was found between the VBQ score and the C-VBQ score (r = 0.757, P < 0.001). This is the first study, to our knowledge, to assess the degree to which the newly developed C-VBQ score correlates with the VBQ score. We found a strong positive correlation between the scores. [ABSTRACT FROM AUTHOR]

Psychological traits, such as character strengths, have been already established in experimental studies as factors playing a favorable role for well-being and potentially reducing the risk of depression. Positive associations have been also reported between character strengths and physical fitness, self-reported physical and mental health. Yet, evidence with large scale, epidemiological data on the role of character strength of honesty and integrity (CSHI) in shaping subsequent health outcomes and daily functioning remains unexplored. We examined whether the character strength of honesty and integrity was prospectively associated with six physical health outcomes, two depression outcomes, and two daily functioning outcomes. We used data from the Health and Retirement Study obtained from a sample of 9813 older adults. We found that after a 4-year follow-up period, compared with individuals who scored the lowest in CSHI, participants who scored in the third tertile had a 18% lower risk of lung disease (RR = 0.824; 95% CI = 0.732; 0.927), and a 11% lower risk of depression (RR = 0.891; 95% CI = 0.806; 0.986). They also reported lower limitations in mobility (β = −0.048; 95% CI (−0.089; −0.008)] and less difficulty in instrumental activities of daily living [β = −0.088; 95% CI (−0.128; −0.047)]. These associations were independent of demographics, prior socioeconomic status, psychological factors, health conditions, and health behaviors. Policy makers and practitioners may consider the character strength of honesty and integrity as a factor for promoting healthy longevity, limiting risks of becoming physically inactive and reducing risk of physical and mental disease. • The role of character strength of honesty and integrity (CSHI) for health is examined. • CSHI is a significant predictor of subsequent physical and mental health outcomes. • CSHI is significantly associated with subsequent daily functioning outcomes. • CSHI may be a factor for promoting healthy longevity. [ABSTRACT FROM AUTHOR]

Objectives: Among patients with T2N0M0 glottic larynx cancer undergoing definitive radiotherapy, recent retrospective and prospective data have suggested improved outcomes with altered fractionation over conventional fractionation (CFxn). We sought to characterize national fractionation patterns and to compare outcomes among them.Materials and Methods: We queried the National Cancer Database for T2N0M0 squamous cell carcinomas of the glottis diagnosed from 2004-2014 and managed with definitive radiotherapy. Dose-per-fraction and duration of radiotherapy were used to define cohorts undergoing CFxn, hypofractionation (HypoFxn), and hyperfractionation (HyperFxn). Logistic regression was performed to identify predictors of receiving altered fractionation. Cox regression and propensity-score matching (PSM) analyses were used to compare survival between schedules.Results: We abstracted 2 006 CFxn patients, 1 166 HypoFxn patients, and 161 HyperFxn patients. Fractionation patterns changed significantly from 2004 to 2014, with use of HyperFxn decreasing from 6.3% to 1.8% and use of HypoFxn increasing from 23.9% to 54.1% (p<0.001). Receipt of altered fractionation was independently associated with later year of diagnosis and higher facility volume. On Cox regression, both HypoFxn (hazard ratio [HR] for mortality 0.84, 95% confidence interval [95%CI] 0.73-0.97) and HyperFxn (HR 0.74, 95%CI 0.56-0.99) were associated with improved survival over CFxn. The survival advantage of each altered fractionation schedule over CFxn was redemonstrated on comparison of PSM groups.Conclusion: Increasing utilization of HypoFxn for T2N0M0 glottic cancer is driving national practice patterns away from CFxn. Our findings support the use of altered fractionation, particularly HypoFxn, for patients undergoing definitive radiotherapy, although HyperFxn remains understudied in a prospective fashion. [ABSTRACT FROM AUTHOR]

Purpose: To characterize practice patterns, including temporal trends, in fractionation schedules among patients in the United States undergoing definitive radiation therapy for early-stage glottic cancer and to compare overall survival outcomes between fractionation schedules.Methods and Materials: We queried the National Cancer Database for patients with TisN0M0, T1N0M0, or T2N0M0 squamous cell carcinoma of the glottic larynx diagnosed between 2004 and 2012 and undergoing definitive radiation therapy. Dose per fraction was calculated to define cohorts undergoing conventional fractionation (CFxn) and hypofractionation (HFxn). Logistic regression was performed to identify predictors of receiving HFxn, and Cox regression was used to determine predictors of death. One-to-one propensity score matching was then used to compare survival between fractionation schedules.Results: The study included 10,539 patients, with 6576 undergoing CFxn and 3963 undergoing HFxn. Patients with T1 disease comprised a majority of each cohort. Use of HFxn increased significantly over the period studied (P<.001), but even in the final year, nearly one-half of patients continued to receive CFxn. Receipt of HFxn was also independently associated with higher income and facility types other than community cancer programs on logistic regression. On multivariate Cox regression, HFxn was associated with improved survival (hazard ratio [HR] for death, 0.90; 95% confidence interval [CI], 0.83-0.97; P=.008), a finding redemonstrated on univariate Cox regression among a well-matched cohort after propensity score matching (HR, 0.88; 95% CI, 0.80-0.96; P=.003). Subgroup Cox multivariate analysis demonstrated a significant survival advantage with HFxn among patients with T1 disease (HR, 0.90; 95% CI, 0.81-0.99; P=.042) but a nonsignificant benefit among those with Tis (HR, 0.86; 95% CI, 0.57-1.30; P=.472) or T2 (HR, 0.88; 95% CI, 0.76-1.02; P=.099) disease.Conclusions: Use of HFxn is increasing and is associated with improved survival over CFxn. Our findings support the broadened use of HFxn for patients with early-stage glottic cancer undergoing definitive radiation therapy. [ABSTRACT FROM AUTHOR]