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Simple Summary: Stereotactic ablative radiation (SAbR) is a focused, high-dose radiation technique used to treat cancers that have spread to the adrenal glands. One of the feared consequences of this therapy is causing adrenal insufficiency in patients, which is a lack of adrenal function; however, the rates and severity at which this occurs in patients are still poorly studied. We studied patients with 66 treated adrenal glands using SAbR, which demonstrated that this technique was effective at controlling cancer sites with a control rate of 75% at 1 year. The risk of patients developing adrenal insufficiency in the entire cohort was significant at 14%, with a median time of 4.3 months. There was a higher risk in patients who had both adrenal glands treated with SAbR, or who had received a prior surgical removal of their other adrenal gland prior to SAbR therapy, with 44% of these patients developing adrenal insufficiency. Background: Adrenal metastases are often treated with stereotactic ablative radiation (SAbR). We aimed to assess the incidence, timing, and factors associated with the development of primary adrenal insufficiency (PAI) following SAbR. Methods: A retrospective cohort study comprised 66 consecutive patients (73% men, median age 61 years) who underwent SAbR for adrenal metastasis. Results: The series encompassed metastases from renal cell carcinoma (41%), lung tumors (38%), colorectal adenocarcinoma (9%), melanoma (5%), and others (7%). Median follow-up was 17 months from SAbR. Nine (14%) patients developed PAI at a median of 4.3 months (range, 0.7–20.2). The incidence of PAI was 44% in patients with prior adrenalectomy receiving unilateral SAbR, 44% with bilateral SAbR, 2% with unaffected contralateral gland, and 0% with bilateral metastases treated with unilateral SAbR. PAI was associated with prior adrenalectomy (odds ratio [OR] 32) and bilateral SAbR (OR 8.2), but not age, sex, metastasis size, or biological effective dose. Post-SAbR 6-month and 1-year local control rates were 82% and 75%, respectively. Conclusions: Patients undergoing SAbR for adrenal metastasis are at high risk of developing PAI. PAI is associated with bilateral SAbR and contralateral adrenalectomy. PAI is unlikely with a remaining unaffected adrenal gland or in the setting of bilateral adrenal metastases with unilateral SAbR. [ABSTRACT FROM AUTHOR]

Refugees in the United States are believed to be at high risk of COVID-19. A cross-sectional study design was utilized to collect anonymous, online surveys from refugee communities in the United States during December 2020 to January 2021. We invited bilingual community leaders to share the survey link with other refugees aged ≥18 years. We identified factors associated with COVID-19 infection and measured the distribution of contact tracing among those who tested positive. Of 435 refugees who completed the survey, 26.4% reported testing positive for COVID-19. COVID-19 infection was associated with having an infected family member and knowing people in one's immediate social environment who were infected. Among respondents who tested positive, 84.4% reported that they had been contacted for contact tracing. To prepare for future pandemics, public health authorities should continue partner with refugee community leaders and organizations to ensure efficient programs are inclusive of refugee communities. [ABSTRACT FROM AUTHOR]

This article aims to analyse bibliometric-based male dominance with the keyword "male dominance" as search input. The Scopus.com web link is used in searching document databases with the type "article" about dominance studies worldwide. Bibliometric data were analysed using VOSviewer Type 1.6.18 software to visualise the network of authors, years, countries, keywords, and study depth related to the issue of male dominance. An analysis conducted on December 18, 2022, found 704 documents between 2000 and 2023. The research results show that, first, in the last six years (2017–2022), the number of publications about domination has grown significantly. Second, the United States is a country that contributes the most significant and productive number of publications in the world related to dominance studies. Third, the main keywords often used in dominance articles are women, state, murder, crime, violence, family, Islam, society, women's status, and gender. Furthermore, fourthly, the latest keywords used are relationship, west, historian, religion, Islamic law, and Christianity. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the risk of maintenance immunosuppression on the post-transplant risk of malignancy across all solid organ transplant types. Methods: This is a retrospective cohort study from a multicenter hospital system in the United States. The electronic health record was queried from 2000 to 2021 for cases of solid organ transplant, immunosuppressive medications, and posttransplant malignancy. Results: A total of 5,591 patients, 6,142 transplanted organs, and 517 posttransplant malignancies were identified. Skin cancer was the most common type of malignancy at 52.8%, whereas liver cancer was the first malignancy to present at a median time of 351 days post-transplant. Heart and lung transplant recipients had the highest rate of malignancy, but this finding was not significant upon adjusting for immunosuppressive medications (heart HR 0.96, 95% CI 0.72 - 1.3, p = 0.88; lung HR 1.01, 95% CI 0.77 - 1.33, p = 0.94). Random forest variable importance calculations and time-dependent multivariate cox proportional hazard analysis identified an increased risk of cancer in patients receiving immunosuppressive therapy with sirolimus (HR 1.41, 95% CI 1.05 - 1.9, p = 0.04), azathioprine (HR 2.1, 95% CI 1.58 - 2.79, p < 0.001), and cyclosporine (HR 1.59, 95% CI 1.17 - 2.17, p = 0.007), while tacrolimus (HR 0.59, 95% CI 0.44 - 0.81, p < 0.001) was associated with low rates of post-transplant neoplasia. Conclusion: Our results show varying risks of immunosuppressive medications associated with the development of post-transplant malignancy, demonstrating the importance of cancer detection and surveillance strategies in solid organ transplant recipients. [ABSTRACT FROM AUTHOR]

Informal learning environments play a critical role in science, technology, engineering, and mathematics learning across the lifespan and are consequential in informing public understanding and engagement. This can be difficult to accomplish in life science where expertise thresholds and logistics involved with handling biological materials can restrict access. Community laboratories are informal learning environments that provide access to the resources necessary to carry out pursuits using enabling biotechnologies. We investigate a group of these spaces in order to ascertain how this occurs—with specific attention to how material and intellectual resources are structured and shape learning. Using surveys and focus group interviews, we explore a group of these spaces located in the United States. We found that the spaces examined offer learning activities that are sufficiently scaffolded and flexible as to promote personalized and community-driven practice. We discuss these findings in relation to informal learning environment design and learning. [ABSTRACT FROM AUTHOR]

Context: Current evidence on determinants of quality of life (QoL) in patients with adrenal insufficiency (AI) is limited. Objective: This work aimed to identify the determinants of QoL in different subtypes of AI. Methods: This multicenter cross-sectional survey study was conducted using a patient-centered questionnaire, the Short Form-36. Results: Of 529 participants, 223 (42.2%) had primary AI, 190 (35.9%) had secondary AI, and 116 (21.9%) had glucocorticoid-induced AI. Median age was 58 years (interquartile range: 43-68 years) and 342 (64.8%) were women. In multivariable analyses, patients were more likely to report worse physical scores if they were women (odds ratio [OR]: 3.3; 95% CI, 1.8-6.0), had secondary AI or glucocorticoid-induced AI (OR: 2.5; 95% CI, 1.4-4.3), had shorter duration of AI (OR: 2.0; 95% CI, 1.1-3.6), were treated with more than 25 mg hydrocortisone equivalent daily (OR: 2.3; 95% CI, 1.2-4.6), had more comorbidities related to glucocorticoid excess (OR: 2.3; 95% CI, 1.3-4.0), reported a higher financial burden from AI (OR: 2.1; 95% CI, 1.3-3.6), and reported difficulties with AI management (OR: 2.5; 95% CI, 1.2-5.2). Women (OR: 2.1; 95% CI, 1.08-4.0), shorter duration of AI (OR: 2.4; 95% CI, 1.4-4.3), higher financial burden (OR: 2.3; 95% CI, 1.3-4.0), difficulties with AI management (OR: 2.6; 95% CI, 1.4-4.9), and lack of family support (OR: 9.1; 95% CI, 2.3-33.3) were associated with worse mental component scores. Conclusion: In patients with AI, QoL could be improved by addressing certain determinants, such as avoiding GC overreplacement, providing in-depth education on self-management, offering more comprehensive insurance coverage, and ensuring better family support. [ABSTRACT FROM AUTHOR]

COVID-19 has created shortages of personal protective equipment. In resource-constrained situations, limited cycles of disinfection and extended use of gloves is recommended by the U.S. Centers for Disease Control and Prevention to conserve supplies. However, these guidelines are based on limited evidence. In this study, serial cycles of hand hygiene were performed on gloved hands using an ethanol-based hand rub (six and 10 cycles), 0.1% sodium hypochlorite (bleach) solution (10 cycles), or soap and water (10 cycles) on latex and nitrile medical exam gloves from the United States and India. A modified water-leak test evaluated glove integrity after repeated applications of these disinfecting agents. When aggregated, dilute bleach demonstrated the lowest difference between treatment and control arms: −2.5 percentage points (95% CI: −5.3 to 0.3) for nitrile, 0.6 percentage points (95% CI: −2.6 to 3.8) for non-powdered latex. For U.S.-purchased gloves tested with six and 10 applications of ethanol-based hand rub, the mean difference in failure risk between treatment and control gloves was within the prespecified non-inferiority margin of five percentage points or less, though some findings were inconclusive since outside the margin. The aggregated difference in failure risk between treatment and control was 3.5 percentage points (0.6 to 6.4) for soap and water, and 2.3 percentage points (−0.5 to 5.0) and 5.0 percentage points (1.8 to 8.2) for 10 and 6 applications of ethanol-based hand rub, respectively. Most leaks occurred in the interdigital webs (35%) and on the fingers (34%). This indicates that some combinations of glove types and disinfection methods may allow for extended use. Ten applications of dilute bleach solution had the least impact on glove integrity. However, the majority of glove and exposure combinations were inconclusive. Additional testing of specific glove and disinfectant combinations may inform future strategies to guide extended use during glove shortages. Additional considerations, not evaluated here, include duration of use, disinfectant chemical permeation, and the effects of hand temperature, movement, and manipulation of instruments on glove integrity. [ABSTRACT FROM AUTHOR]

Objective: Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy. Methods: From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance. Results: Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons. Conclusion: Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees. [ABSTRACT FROM AUTHOR]

This study reports a new and significantly enhanced analysis of US flood hazard at 30 m spatial resolution. Specific improvements include updated hydrography data, new methods to determine channel depth, more rigorous flood frequency analysis, output downscaling to property tract level, and inclusion of the impact of local interventions in the flooding system. For the first time, we consider pluvial, fluvial, and coastal flood hazards within the same framework and provide projections for both current (rather than historic average) conditions and for future time periods centered on 2035 and 2050 under the RCP4.5 emissions pathway. Validation against high‐quality local models and the entire catalog of FEMA 1% annual probability flood maps yielded Critical Success Index values in the range 0.69–0.82. Significant improvements over a previous pluvial/fluvial model version are shown for high‐frequency events and coastal zones, along with minor improvements in areas where model performance was already good. The result is the first comprehensive and consistent national‐scale analysis of flood hazard for the conterminous US for both current and future conditions. Even though we consider a stabilization emissions scenario and a near‐future time horizon, we project clear patterns of changing flood hazard (3σ changes in 100 years inundated area of −3.8 to +16% at 1° scale), that are significant when considered as a proportion of the land area where human use is possible or in terms of the currently protected land area where the standard of flood defense protection may become compromised by this time. Plain Language Summary: We develop a method to estimate past, present, and future flood risk for all properties in the conterminous United States whether affected by river, coastal or rainfall flooding. The analysis accounts for variability within environmental factors including changes in sea level rise, hurricane intensity and landfall locations, precipitation patterns, and river discharge. We show that even for a conservative climate change trajectory we can expect locally significant changes in the land area at risk from floods by 2050, and by this time defenses protecting 2,200 km2 of land may be compromised. The complete dataset has been made available via a website (https://floodfactor.com/) created by the First Street Foundation in order to increase public awareness of the threat posed by flooding to safety and livelihoods. Key Points: First complete high‐resolution flood hazard analysis of conterminous US flood risk from all major sources (fluvial, pluvial, and coastal)In validation tests the model achieved Critical Success Index scores of 0.69–0.82, similar to many local custom‐built 2D modelsBy 2050, flood hazard increases for the Eastern seaboard and Western states, but decreases or changes little for the center and South‐West [ABSTRACT FROM AUTHOR]

Providing access to a variety of healthy and affordable foods has been the goal of several federal and state policy initiatives in the USA. The first step towards the successful implementation of these initiatives is to identify food deserts and to understand the mechanism by which food deserts arise. This national-level study investigates the association between urban sprawl and the emergence of food deserts at both regional and neighbourhood levels. Multilevel analysis is used to model the likelihood of a census tract being a food desert, controlling for sociodemographic and built environmental characteristics. We find that urban sprawl, measured via a compactness index, holds a significant association with the likelihood of a census tract being a food desert. Specifically, a one unit increase in the compactness index is associated with a 5.6% decrease in the odds of a census tract being a food desert. In conclusion, we recommend increasing the land use density, mix and walkability of neighbourhoods to create a supportive and attractive environment for food retailers in which to invest. [ABSTRACT FROM AUTHOR]

Problem, research strategy, and findings: The monocentric development pattern in the Alonso–Mills–Muth model underpinned theoretical discussions of urban form in the 1960s and 1970s and truly dominated theory up to the point when Joel Garreau published Edge City: Life on the New Frontier in the early 1990s. Monocentric development patterns remain dominant to this day among smaller metropolitan areas in the United States. However, for larger metropolitan areas in the United States, regional transportation plans suggest a paradigm shift to a polycentric structure. We review 126 regional transportation plans in the United States and find that a hierarchy of centers connected by high-quality transit has become the dominant vision for most of them. The plan for Salt Lake City (UT), for example, strives for a multicentered region even though secondary centers are only beginning to emerge beyond a dominant downtown. Generally missing from regional transportation plans are quantitative criteria for designating and guiding centers: In no case are the quantitative criteria empirically based on proven transportation benefits. Here we investigate how the built environment characteristics of centers are associated with people's travel mode choices and vehicle use. We employ visual and exploratory approaches through a generalized additive model (GAM) to identify nonlinear relationships between travel outcomes and "D" variables (density, diversity, design, destination accessibility, and distance to transit) within centers. The model and plots help us recommend the built environment characteristics of centers. Takeaway for practice: The built environment thresholds and relevant tools provided here can enable planners to make informed decisions about future growth patterns, set realistic—yet visionary—goals, and improve the overall health of its residents and communities. We provide strategies and tools that planning agencies, such as metropolitan planning organizations, transit agencies, and municipalities, can adopt to channel developments into centers. [ABSTRACT FROM AUTHOR]

The article discusses Matthew Kroenig explores the puzzle of why US policymakers pursue a policy of nuclear superiority when scholars of nuclear strategy have long predicted that in order to deter a nuclear war, states only need enough nuclear weapons for a secure second-strike capability and Kroenig demonstrates the strategic and rational reasons why we often observe states pursuing superiority beyond second-strike capability.

Geography of innovation, creative clustering, urban buzz and innovation districts are place-based concepts that have emerged as a result of the US economy's transformation to knowledge-intensive economies. The notable built environment characteristics of these concepts are spatial clustering, walkability and proximity to urban amenities, diversity, regional connectivity and agglomeration. While several of these characteristics have been associated with urban sprawl in previous studies, there is a lack of direct evidence on how urban sprawl affects innovation productivity. This national study seeks to examine the relationship between urban sprawl, place-based characteristics and innovation productivity. We used Multilevel Modelling to account for built environment characteristics at both neighbourhood and regional levels. We found that innovative firms tend to locate more in census tracts that are less compact but offer spatial proximity to firms in related business sectors. This is likely due to the higher land and property value in compact areas, which could make it unaffordable for small businesses. We also found that the regional compactness positively and significantly affects the number of innovative firms. This is likely due to the role of compact regions in supporting public transit investments, enhancing social capital and reducing poverty and racial segregation. [ABSTRACT FROM AUTHOR]

Abstract The Northeast United States, particularly New York State has experienced an increase in extreme daily precipitation during the past 50 years. Recent events such as Hurricane Irene and Superstorm Sandy, have revealed vulnerability to the intense precipitation within the transportation sector. In the scale of New York City, where transit system is the most dominant mode of transportation and daily mobility of millions of passengers depends on it, any disruption in the transit service would result in gridlocks and massive delays. To assess the impacts of rainfall on the subway ridership, we merged high resolution radar rainfall and subway ridership data to conduct a detailed analysis for each of the 116 subway stations at the borough of Manhattan. The analysis is carried out on both hourly and daily resolution level, where a spatial-temporal Bayesian multi-level regression model is used to capture the underlying dependency between the parameters. The estimation results are obtained through Markov Chain Monte Carlo sampling method. The results for daily analysis indicate that during weekdays, transit ridership in the stations located in commercial zones are less sensitive to the rainfall compared to the ones in residential zones. Highlights • Impacts of spatial variability of rainfall on subway ridership is assessed using large scale ridership and rainfall data. • A unified multi scale model, combining time and spatial scales for ridership is proposed. • The study framework can be used by agencies to improve system efficiency and resilience at the station level. [ABSTRACT FROM AUTHOR]

This article assesses the affordability of U.S. Department of Housing and Urban Development (HUD) rental assistance properties from the perspective of transportation costs. HUD housing is, by definition, affordable from the standpoint of housing costs due to limits on the amounts renters are required to pay. However, there are no such limitations on transportation costs, and common sense suggests that renters in remote locations may be forced to pay more than 15% of income, a nominal affordability standard, for transportation costs. Using household travel models estimated with data from 15 diverse regions around the United States, we estimated and summed automobile capital costs, automobile operating costs, and transit fare costs for households at 8,857 HUD rental assistance properties. The mean percentage of income expended on transportation is 15% for households at the high end of the eligible income scale. However, in highly sprawling metropolitan areas, and in suburban areas of more compact metropolitan areas, much higher percentages of households exceed the 15% ceiling. This suggests that locational characteristics of properties should be considered for renewal when HUD contracts expire for these properties, based on location and hence on transportation affordability. [ABSTRACT FROM PUBLISHER]

A decade ago, compactness/sprawl indices were developed for metropolitan areas and counties which have been widely used in health and other research. In this study, we first update the original county index to 2010, then develop a refined index that accounts for more relevant factors, and finally seek to test the relationship between sprawl and traffic crash rates using structural equation modelling. Controlling for covariates, we find that sprawl is associated with significantly higher direct and indirect effects on fatal crash rates. The direct effect is likely due to the higher traffic speeds in sprawling areas, and the indirect effect is due to greater vehicle miles driven in such areas. Conversely, sprawl has negative direct relationships with total crashes and non-fatal injury crashes, and these offset (and sometimes overwhelm) the positive indirect effects of sprawl on both types of crashes through the mediating effect of increased vehicle miles driven. The most likely explanation is the greater prevalence of fender benders and other minor accidents in the low speed, high conflict traffic environments of compact areas, negating the lower vehicle miles travelled per capita in such areas. [ABSTRACT FROM AUTHOR]

Across the nation, the debate over metropolitan sprawl and its impacts continues decade after decade. To elevate the debate, a decade ago, researchers developed compactness/sprawl indices for metropolitan areas and counties that have been widely used in health and other research. In this study, we develop refined compactness/sprawl indices based on definitions and procedures in earlier studies by Ewing and colleagues and validate them against transportation outcomes. The indices are being made available to researchers who wish to study the causes, costs and benefits, and solutions to sprawl and to practitioners who wish to check their community’s success in containing sprawl. [ABSTRACT FROM PUBLISHER]

Vehicle miles travelled (VMT) is a primary performance indicator for land use and transportation, bringing with it both positive and negative externalities. This study updates and refines previous work on VMT in urbanised areas, using recent data, additional metrics and structural equation modelling (SEM). In a cross-sectional model for 2010, population, income and freeway capacity are positively related to VMT, while gasoline prices, development density and transit service levels are negatively related. Findings of the cross-sectional model are generally confirmed in a more tightly controlled longitudinal study of changes in VMT between 2000 and 2010, the first model of its kind. The cross-sectional and longitudinal models together, plus the transportation literature generally, give us a basis for generalising across studies to arrive at elasticity values of VMT with respect to different urban variables. [ABSTRACT FROM PUBLISHER]

Highlights: [•] Compactness indices paint a plausible picture of sprawl and changes in sprawl in the U.S. [•] Generalizing, compactness decreased and sprawl increased between 2000 and 2010. [•] The overall compactness index bears a strong relationship to transportation outcomes. [•] Two of the four individual compactness factors also bear strong relationships to outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Presently, hysterosalpingography (HSG) is used as a means to evaluate women with infertility and repetitive pregnancy loss. Venous intravasation is a complication and potential pitfall during HSG and analogous procedures including hysteroscopy. The aim of our study was to assess the venous intravasation and to obtain critical information for more secure and more accurate procedures. In particular, the primary goal of the present study was to compare HSG without and with intravasation to identify differences seen on HSG and to assess the predisposing factors of intravasation. The secondary goal was to describe clinical- and imaging-based novel classification of intravasation. Materials and Methods: This study included a patient cohort of 569 patients who underwent HSG between 2008 and 2011 at our center in the absence (control group) or presence (study group) of intravasation. Intravasation classified from level 0 (no intravasation) to level 3 (severe intravasation) was compared with preprocedural (demographic and clinical) and procedural (HSG) data. Data were analyzed using Statistical Package for Social Sciences (SPSS) statistical software. Results: Of the 569 patients undergoing HSG, 528 showed no intravasation and 41 (7.2%) patients showed intravasation when associated with preprocedural (leukocytes, menometrorrhagia, secondary infertility, ectopic pregnancy, abortus, polycystic ovaries, endometriosis, and interventions) and procedural (pain, scheduling, endometrial-uterine nature, and spillage) parameters. Moreover, intravasation was lower in women with smooth endometrium, triangular uterus, and homogeneous peritoneal spillage. No association was found between age, tubal patency, increased pressure, and intravasation. Conclusions: Using a novel classification method, www.clinicalimagingscience.org For entire Editorial Board visit : www.clinicalimagingscience.org/editorialboard.asp Editor-in-Chief: Vikram S. Dogra, MD Department of Imaging Sciences, University of Rochester Medical Center, Rochester, USA OPEN ACCESS HTML format ORIGINAL ARTICLE Access this article online Quick Response Code: Website: www.clinicalimagingscience.org DOI: 10.4103/2156-7514.124105 Address for correspondence: Dr. Abdurrahim Dusak, Department of Radiology, Dicle University, Faculty of Medicine, 21280 Diyarbakir, Turkey. E-mail: adusak@gmail.com Received : 30-09-2013 Accepted : 16-12-2013 Published : 31-12-2013 Copyright: © 2013 Dusak A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This article may be cited as: Dusak A, Soydinc HE, Onder H, Ekinci F, Görük NY, Hamidi C, Bilici A. Venous Intravasation as a Complication and Potential Pitfall During Hysterosalpingography: Re-Emerging Study with a Novel Classification. J Clin Imaging Sci 2013;3:67. Available FREE in open access from: http://www.clinicalimagingscience.org/text.asp?2013/3/1/67/124105 intravasation can be observed in women during HSG and associates with preprocedural and procedural predisposing factors in subsumed conditions. This classification method will be useful for improving the efficiency and accuracy of HSG and related procedures by minimization of severe complications caused by intravasation. [ABSTRACT FROM AUTHOR]

Government regulations affect corporations and consumers on a daily basis. For example, environmental and safety regulations in the workplace are administrated by the Occupational Safety and Health Administration (OSHA) under the Department of Labor. OSHA sets and enforces standards in work environment to ensure the safety and health of workers. Other regulatory agencies, such as the National Highway and Transportation Agency (NHTSA), oversee the transportation and the safety of the automobile and truck industry. The U.S. Food and Drug Administration (FDA) plays a major role in approving new drugs on the market and in monitoring drug safety, and it has the power to remove drugs from the market if they are proved to be safety and health problems to the public. However, the mere existence of these regulations often causes impediments to businesses, and the extent of their ultimate usefulness is examined and analyzed in this paper. [ABSTRACT FROM AUTHOR]

Transthyretin Val122Ile is one of greater than 80 mutations in transthyretin (TTR) that are associated with hereditary amyloidosis. Retrospective studies have shown a prevalence of this mutation as high as 3.9% in African-Americans. The present study was undertaken to determine in a prospective fashion the prevalence of the TTR Val122Ile allele in African-Americans in a Midwestern American city. DNA was isolated from cord bloods collected at the time of birth in the County hospital of Indianapolis, Indiana. Samples were identified only as to ethnic origin of the mother. Analysis was performed by PCR amplification of TTR exon 4 followed by SSCP and RFLP. Cord bloods from 1,973 children born at the County hospital were analyzed. Thirty of 1,000 DNA samples from African-American newborns were positive for TTR Val122Ile (3%). Two of 453 DNA samples from Caucasian newborns were positive (0.44%). Zero of 490 DNA samples from newborns of Hispanic mothers and 0 of 30 from newborns with mothers classified as other (including Asian) were positive. This prospective study demonstrates that 3% of newborns of African-American women in an urban population have the TTR Val122Ile mutation which is associated with late-onset cardiomyopathy. The degree of penetrance of this mutation at the clinical level has not yet been determined. [ABSTRACT FROM AUTHOR]

• Travel reductions during the shelter-in-place change over time in a nonlinear form. • Park trips have the least reduction (0.4%, on average) among all three destinations. • Trip to transit stations has the highest reduction (average 37%) of all destinations. • Compact development leads to a significantly lower reduction in park trips. • Compactness leads to a significantly higher reduction in grocery and transit trips. In the absence of a vaccine and medical treatments, social distancing remains the only option available to governments in order to slow the spread of global pandemics such as COVID-19 and save millions of lives. Despite the scientific evidence on the effectiveness of social distancing measures, they are not being practiced uniformly across the U.S. Accordingly, the role of compact development on the level of adherence to social distancing measures has not been empirically studied. This longitudinal study employs a natural experimental research design to investigative the impacts of compact development on reduction in travel to three types of destinations representing a range of essential and non-essential trips in 771 metropolitan counties in the U.S during the shelter-in-place order amid the COVID-19 pandemic. We employed Multilevel Linear Modeling (MLM) for the three longitudinal analyses in this study to model determinants of reduction in daily trips to grocery stores, parks, and transit stations; using travel data from Google and accounting for the hierarchical (two-level) structure of the data. We found that the challenges of practicing social distancing in compact areas are not related to minimizing essential trips. Quite the opposite, residents of compact areas have significantly higher reduction in trips to essential destinations such as grocery stores/pharmacies, and transit stations. However, residents of compact counties have significantly lower reduction in their trips to parks possibly due to the smaller homes, lack of private yards, and the higher level of anxiety amid the pandemic. This study offers a number of practical implications and directions for future research. [ABSTRACT FROM AUTHOR]

This longitudinal study aims to investigative the impacts of development density on the spread and mortality rates of COVID-19 in metropolitan counties in the United States. Multilevel Linear Modeling (MLM) is employed to model the infection rate and the mortality rate of COVID-19, accounting for the hierarchical (two-level) and longitudinal structure of the data. This study finds that large metropolitan size (measured in terms of population) leads to significantly higher COVID-19 infection rates and higher mortality rates. After controlling for metropolitan size and other confounding variables, county density leads to significantly lower infection rates and lower death rates. These findings recommend that urban planners and health professionals continue to advocate for compact development and continue to oppose urban sprawl for this and many other reasons documented in the literature, including the positive relationship between compact development and fitness and general health. [ABSTRACT FROM AUTHOR]

Metastatic pheochromocytoma and paraganglioma (PPGL) are incurable neuroendocrine tumors. The goals of treatment include palliating symptoms and reducing tumor burden. Little is known about the use of radiofrequency ablation (RFA), cryoablation (CRYO), and percutaneous ethanol injection (PEI) to treat metastatic PPGL. We performed a retrospective study of patients age 17 years and older with metastatic PPGL who were treated with ablative therapy at Mayo Clinic, USA, between June 14, 1999 and November 14, 2017. Our outcomes measures were radiographic response, procedure-related complications, and symptomatic improvement. Thirty-one patients with metastatic PPGL had 123 lesions treated during 42 RFA, 23 CRYO, and 4 PEI procedures. The median duration of follow-up was 60 months (range, 0–163 months) for non-deceased patients. Radiographic local control was achieved in 69/80 (86%) lesions. Improvement in metastasis-related pain or symptoms of catecholamine excess was achieved in 12/13 (92%) procedures. Thirty-three (67%) procedures had no known complications. Clavien-Dindo Grade I, II, IV, and V complications occurred after 7 (14%), 7 (14%), 1 (2%), and 1 (2%) of the procedures, respectively. In patients with metastatic PPGL, ablative therapy can effectively achieve local control and palliate symptoms. [ABSTRACT FROM AUTHOR]

Gallbladder cancer has a poor prognosis, and surgery is the only curative treatment. However, lymphadenectomy has been underperformed. We evaluate the trend of lymphadenectomy in the United States and its impact on survival. This is a cohort study of patients who underwent gallbladder cancer surgery between 2004 and 2016. Trend analysis of the rate of lymphadenectomy and the number of lymph nodes (LNs) removed were examined. The impact of lymph node status and different LN staging systems on survival was examined. Of the 4577 patients identified, 69.9% were female, the mean age was 71.0 (±12.4), 87.2% had ≥ T2, and only 50.3% (n = 2302) received lymphadenectomy. Although the rate of lymphadenectomy and the number of LNs removed increased during the study period, both with P < 0.0001, the rate of patients who received examination of ≥6 LNs remained low, 13.6% in 2016. Adjusted regression analysis showed that patients without LN examination had worse overall survival than patients with LN positive disease, HR: 1.11 (95% CI: 1.01, 1.22). Concordance index analysis revealed that LN ratio (LNR) and Log odds of positive LN (LODDS) did not improve the ability of the American Joint Commission on Cancer (AJCC) staging in predicting 5-y survival rate. Lack of LN examination is associated with worse survival than LN positive disease. Although the rate of LN examination and number of LNs retrieved have increased from 2004 to 2016, they remained low. LNR and LODDS staging systems added no benefit to AJCC staging ability in predicting a 5-y survival rate. [ABSTRACT FROM AUTHOR]

Background: In the United States, there is a national shortage of organs donated for transplant. Among the solid organs, most often kidneys are donated by living donors, but the lack of information and complicated processes limit the number of individuals who serve as living kidney donors. Social media can be a tool for advocacy, educating the public about the need, process, and outcomes of live kidney donors, yet little is known about social media use by kidney transplant patients.Objective: The purpose of this study was to examine the social media use of potential kidney transplant patients and their willingness to use social media and their networks to advocate and educate about living kidney donation.Methods: Using a validated survey, we modified the instrument to apply to the patient population of interest attending the Medical University of South Carolina, Charleston, SC, USA. The questions on the survey inquired about current social media use, sites visited, frequency and duration of social media use, and willingness to use social media to share the need for living kidney donors. We asked patients who had received a transplant and those awaiting a transplant to complete the survey during an office visit. Participation was voluntary.Results: A total of 199 patients completed the survey. Approximately half of all kidney transplant patients surveyed used social media (104/199, 52.3%), and approximately one-third (66/199, 33.2%) had more than 100 friends in their social media network. Facebook was the most popular site, and 51% (102/199) reported that they would be willing to post information about living kidney donation on their social networks. More than a quarter of the sample (75/199, 37.7%) had posted about their health status in the past.Conclusions: Social media holds great promise for health-related education and awareness. Our study shows the current social media use of kidney transplant patients. In turn, such information can be used to design interventions to ensure appropriate decision making about live kidney donation. Transplant programs can help increase the number of living donors by providing guidance to kidney transplant patients in how to use social media, to be advocates, and to provide information about living kidney donation to their social network. [ABSTRACT FROM AUTHOR]

Purpose: This study examines the management and outcomes of muscle-invasive bladder cancer in the United States. Methods and Materials: Patients with muscle-invasive bladder cancer diagnosed between 1988 and 2006 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified according to three mutually exclusive treatment categories based on the primary initial treatment: no local management, radiotherapy, or surgery. Overall survival was assessed with Kaplan-Meier analysis and Cox models based on multiple factors including treatment utilization patterns. Results: The study population consisted of 26,851 patients. Age, sex, race, tumor grade, histology, and geographic location were associated with differences in treatment (all p < 0.01). Patients receiving definitive radiotherapy tended to be older and have less differentiated tumors than patients undergoing surgery (RT, median age 78 years old and 90.6% grade 3/4 tumors; surgery, median age 71 years old and 77.1% grade 3/4 tumors). No large shifts in treatment were seen over time, with most patients managed with surgical resection (86.3% for overall study population). Significant survival differences were observed according to initial treatment: median survival, 14 months with no definitive local treatment; 17 months with radiotherapy; and 43 months for surgery. On multivariate analysis, differences in local utilization rates of definitive radiotherapy did not demonstrate a significant effect on overall survival (hazard ratio, 1.002; 95% confidence interval, 0.999–1.005). Conclusions: Multiple factors influence the initial treatment strategy for muscle-invasive bladder cancer, but definitive radiotherapy continues to be used infrequently. Although patients who undergo surgery fare better, a multivariable model that accounted for patient and tumor characteristics found no survival detriment to the utilization of definitive radiotherapy. These results support continued research into bladder preservation strategies and suggest that definitive radiotherapy represents a viable initial treatment strategy for those who wish to attempt to preserve their native bladder. [Copyright &y& Elsevier]