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BackgroundCow's milk (CM) is one of the leading causes of food allergy in children. However, approximately 85% of milk-allergic children become clinically tolerant to CM within the first 3 years of life. The mechanisms involved in the achievement of tolerance remain unknown. ObjectiveTo study whether IgE antibodies from children with persistent cow's milk allergy (CMA) differ from children who become clinically tolerant in their ability to recognize linear and conformational epitopes of αs1- and β-casein. MethodsThirty-six milk-allergic children were included in the study: 11 of the children became clinically tolerant, and 25 had persistent CMA. Blood was obtained from all patients during the time they showed clinical reactions to milk challenge. Six non-milk-allergic children served as controls. Specific IgE antibodies against linear (denatured) as well as conformational (native) milk proteins were determined by probing dot-blots with patients' sera. In addition, selected decapeptides from αs1- and β-casein, previously found to be suggestive of persistent CMA, were synthesized on a cellulose-derivatized membrane and probed with individual sera from 10 patients who outgrew CMA and from 10 patients with persistent CMA. ResultsAnalysis of immunodot-blots showed that, in comparison to tolerant patients, milk-allergic children with persistent symptoms had a significantly higher ratio of specific IgE antibodies to linearized than to native α- and β-casein (P < 0.005 and P < 0.02, respectively). Comparing the selected decapeptides, six of the 10 patients with persistent allergy recognized the peptide corresponding to amino acids 69–78 from αs1-casein while none of the patients who outgrew CMA had IgE binding to this epitope. ConclusionPatients with persistent milk allergy possess higher detectable levels of IgE antibodies to linear epitopes from αs1- and β-casein than... [ABSTRACT FROM AUTHOR]

This study examines the persistent impacts of historical racebased discriminatory housing policies on contemporary urban environments in the United States. Specifically, we examine the relationships between Home Owners' Loan Corporation (HOLC) grades assigned to neighborhoods in the 1930s and the current distribution of tree canopy and level of exposure to air pollution hazards. Our results indicate a clear gradient in tree canopy by HOLC grade, with better neighborhood grades associated with significantly higher percentage of tree canopy coverage. The pattern also exists for airborne carcinogens and respiratory hazards, with worse neighborhood grades associated with significantly higher hazards exposure. Our findings indicate that early 20th century discriminatory housing policies exert a contemporary influence on patterns of green space exposure in American cities, with implications for health and health inequities. Our findings suggest that, in order to achieve equitable access to the benefits of urban greenspace, we must acknowledge these historical influences and consider policies and practices that directly counter these influences, for example, through targeted greenspace development in areas historically identified as unfit for investment. • Increasing urban tree canopy is a recognized strategy to reduce air pollutants. • There is a systematic disparity in spatial distributions of urban tree canopy. • Current levels of tree canopy reflect a gradient established by the HOLC maps. • There is a similar gradient in airborne carcinogens and respiratory hazards. [ABSTRACT FROM AUTHOR]

Objective: To validate the 7 th and 8 th editions of the AJCC staging system for patients with invasive carcinomas arising in association with IPMN (IPMN-associated PDAC)., Background Data: Although several studies have validated AJCC systems in patients with conventional PDAC, their applicability to IPMN-associated PDAC has not been assessed., Methods: Two hundred seventy-five patients who underwent resection for IPMN-associated PDAC between 1996 and 2015 at 3 tertiary centers and had data on the size of the invasive component and lymph node status were identified. Concordance probability estimates (CPE) were calculated and recursive partitioning analysis was employed to identify optimal prognostic cutoffs for T and N., Results: The CPE for the 7 th and 8 th editions of the AJCC schema were relatively good (0.64 for both) and similar for colloid and tubular subtypes (0.64 for both). The 8 th edition introduced T1a sub-staging and a new distinction between N1 and N2. The utility of the former was confirmed, although the latter did not improve prognostic discrimination. The successful validation of the 8th edition of the AJCC criteria in patients with tubular and colloid subtypes allowed us to compare these patients in early vs late T and N stages which showed that with advanced disease, the prognostic superiority of colloid tumors over their tubular counterparts diminishes., Conclusions: Our findings support the use of the AJCC 8 th edition in the IPMN-associated PDAC population, but suggest that certain cutoffs may need to be revisited. In advanced AJCC stages, patients with colloid vs tubular subtypes have comparable prognosis., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Yearly influenza vaccination is strongly recommended at age 65 and reimbursed by Medicare without copays or deductibles at pharmacies and clinical settings. Uptake is low among patients with a high risk for influenza complications and good access to specialist care, such as recent cancer survivors. We hypothesized that more accessible pharmacies could be associated with higher immunization uptake in such patients., Objectives: To determine whether pharmacy access is associated with influenza vaccination in subjects recently diagnosed with breast cancer, and whether this association differs by additional risk factors for influenza complications., Methods: We examined a cohort of patients with stage 0-III breast cancer diagnosed 2011-2015 from the Surveillance, Epidemiology, and End Results-Medicare cancer registry. All retail pharmacies in the United States were identified, and pharmacy access was measured by assessing supply and demand in each census tract using a 2-stage floating catchment area approach that accounted for pharmacy driving distances recommended by the Centers for Medicare and Medicaid Services. We examined the association of pharmacy access with influenza vaccination after breast cancer diagnosis in regression models., Results: More than 11% of 45,722 patients with breast cancer lived in census tracts where no pharmacies were within recommended driving distances from the population-weighted tract center. Vaccination in the year after diagnosis was less likely for patients in these very low-access tracts (adjusted odds ratio 0.92 [95% CI 0.86-0.96]), black (0.55 [0.51-0.60]) and Hispanic (0.76 [0.70-0.83]) women, and Medicaid recipients (0.74 [0.69-0.79]). Vaccination was inversely associated with per capita income in the subject's census tract, but there was no difference in the pharmacy effect by race, ethnicity, or census tract income., Conclusion: Very low pharmacy access is associated with modest reductions in vaccination that could be useful for policy and planning regarding vaccinator resources and outreach., (Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Purpose: Real-World Data (RWD) studies are increasingly used to support regulatory approvals, reimbursement decisions, and changes in clinical practice for novel cancer drugs. However, few studies have systematically appraised their quality or compared outcomes to pivotal trials., Methods: All RWD studies (2010-2019) for drugs approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) from 2010 to 2015 for solid organ tumours in the non-curative setting were identified. Quality assessment was undertaken using the Newcastle Ottawa Scale. Survival differences between each RWD study and the pivotal trial were determined using a related sample Wilcoxon signed-rank test., Results: 293 RWD studies for 45 of the 57 drug indications approved by the FDA/EMA were identified. The most common tumour types were prostate cancer (29%, n = 86) and melanoma (15%, n = 43). A quarter of the studies had industry funding. No high-quality studies were identified, and 78% were low quality. Comparative survival analysis between RWD and pivotal trials was possible for 224 studies (37 drug indications). Differences in median survival between the RWD studies and their corresponding trial ranged from -32 months to 21 months (IQR -4·2 months to 1·6 months). Low-quality studies were more likely to report superior survival outcomes (23%) compared to higher quality studies (8%) (p = 0.02)., Conclusion: RWD study quality for novel cancer drugs is low and of insufficient rigour to inform reimbursement decisions and clinical practice. RWD studies seeking publication should provide a completed quality assessment tool on submission. Greater investment in properly designed RWD studies is required., Competing Interests: Conflict of interest The authors have declared no conflicts of interest., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Rationale: Socioeconomic factors are associated with worse disease severity at presentation in sarcoidosis, but the relative importance of socioeconomic variables on morbidity and disease burden has not been fully elucidated. Objectives: To determine the association between income and sarcoidosis outcomes after controlling for socioeconomic and disease-related factors. Methods: Using the Sarcoidosis Advanced Registry for Cures database, we analyzed data from 2,318 patients with sarcoidosis in the United States to determine the effect of income and other variables on outcomes. We divided comorbidities arising after diagnosis into those likely related to steroid use and those likely related to sarcoidosis. We assessed the development of health-related, functional, and socioeconomic outcomes following the diagnosis of sarcoidosis. Measurements and Main Results: In multivariate analysis, low-income patients had significantly higher rates of new sarcoidosis-related comorbidities (<$35,000, odds ratio [OR], 2.4 [1.7-3.3]; $35,000-84,999, OR, 1.4 [1.1-1.9]; and ≥$85,000 [reference (Ref)]) and new steroid-related comorbidities (<$35,000, OR, 1.3 [0.9-2.0]; $35,000-84,999, OR, 1.5 [1.1-2.1]; and ≥$85,000 [Ref]), had lower health-related quality of life as assessed by the Sarcoidosis Health Questionnaire ( P  < 0.001), and experienced more impact on family finances (<$35,000, OR, 7.9 [4.9-12.7]; $35,000-84,999, OR, 2.7 [1.9-3.9]; and ≥$85,000 [Ref]). The use of supplemental oxygen, need for assistive devices, and job loss were more common in lower income patients. Development of comorbidities after diagnosis of sarcoidosis occurred in 63% of patients and were strong independent predictors of poor outcomes. In random forest modeling, income was consistently a leading predictor of outcome. Conclusions: These results suggest the burden from sarcoidosis preferentially impacts the economically disadvantaged.

CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) is the nation's primary data repository for health statistics. Before WONDER data are released to the public, data cells with fewer than 10 case counts are suppressed. We showed that maps produced from suppressed data have predictable geographic biases that can be removed by applying population data in the system and an algorithm that uses regional rates to estimate missing data. By using CDC WONDER heart disease mortality data, we demonstrated that effects of suppression could be largely overcome.

Our study examines the prior offending of 750 individuals who are known to be responsible for the abduction of a child under the age of 18 years. The first group comprised of 311 offenders (42%) who had abducted a child that was later located alive (found alive, referred to as FA). The second group was comprised of 439 offenders (58%) who had abducted a child that was either found murdered or was still missing and presumed dead (found murdered, referred to as FM). While males perpetrated the majority of the abductions, women perpetrated 31 (10%) of the offenses in the FA group and 10 (2%) of the offenses in the FM group. The average number of prior offenses as reflected in the NCIC criminal history of each offender was seven with these occurring over an average of 12 years. Seventy-five percent of the offenders had prior arrests for an assortment of different crimes while 25% had no known criminal history, a finding that was consistent across both the FA and FM groups. Of those with a criminal history, 41% had been arrested for assault, 40% for larceny, 35% for burglary/breaking and entering, 33% for forcible sex offenses, 25% for drug/narcotic offenses, 21% for weapons law violations, 17% for motor vehicle thefts, 15% for robbery, and 14% for kidnapping. Our findings are congruent with the theme of criminal diversity among child abductors and argue against the specificity in offending that is often assumed with this type of sexual offender. This information is relevant to our understanding of the progression in criminal offending that is manifested by offenders who abduct children and will hopefully be used by law enforcement in helping to direct and focus their investigations.

The cosmetic industry, with the advice of individuals familiar with food and drug safety assessment, set up a Cosmetic Ingredient Review panel of experts and an attendant staff in the fall of 1976, which began to function in July 1977. Its structure and role were carefully developed by a steering committee to assure the independence and credibility of the expert panel's deliberations and decisions and the ultimate publication of a final report on each of many ingredients. That report must conclude 1) that there is reasonable certainty that the ingredient is safe under conditions of use, 2) that it is unsafe, or 3) that the evidence is inadequate to make such a judgment. There is considerable variability in the adequacy of the safety assessments or the assessments of safety in the literature and unpublished reports on ingredients that have been reviewed to date.