Search

We investigated the classical question of why visual acuity decreases with decreasing retinal illuminance by holding retinal eccentricity fixed while illumination varied. Our results indicate that acuity is largely independent of illuminance at any given retinal location, which suggests that under classical free-viewing conditions acuity improves as illumination increases from rod threshold to rod saturation because the retinal location of the stimulus is permitted to migrate from a peripheral location of maximum sensitivity but poor acuity to the foveal location of maximum acuity but poor sensitivity. Comparison with anatomical sampling density of retinal neurons suggests that mesopic acuity at all eccentricities and scotopic acuity for eccentricities beyond about 20° is limited by the spacing of midget ganglion cells. In central retina, however, scotopic acuity is further limited by spatial filtering due to spatial summation within the large, overlapping receptive fields of the A-II class of amacrine cells interposed in the rod pathway between rod bipolars and midget ganglion cells. Our results offer a mechanistic interpretation of the clinical metrics for low-luminance visual dysfunction used to monitor progression of retinal disease.

Tobacco use after a cancer diagnosis can increase risk of disease recurrence, increase the likelihood of a second primary cancer, and negatively impact treatment efficacy. The implementation of system-wide comprehensive tobacco cessation in the oncology setting has historically been low, with over half of cancer clinicians reporting that they do not treat or provide a referral to cessation resources. This quality improvement study evaluated the procedures for assessing and documenting tobacco use among cancer survivors and referring current smokers to cessation resources at the University of Virginia Cancer Center. Process mapping revealed 20 gaps across two major domains: electronic health record (EHR), and personnel barriers. The top identified priority was inconsistent documentation of tobacco use status as it impacted several downstream gaps. Eleven of the 20 gaps were deemed a high priority, and all were addressed during the implementation of the resulting Tobacco Treatment Program. Prioritized gaps were addressed using a combination of provider training, modifications to clinical workflow, and EHR modifications. Since implementation of solutions, the number of unique survivors receiving cessation treatment has increased from 284 survivors receiving cessation support during Year 1 of the initiative to 487 in Year 3. The resulting Tobacco Treatment Program provides a systematic, personalized, and sustainable comprehensive cessation program that optimizes the multifaceted workflow of the Cancer Center and has the potential to reduce tobacco use in a population most in need of cessation support.

Introduction: The National Cancer Institute (NCI) Center to Reduce Center Health Disparities (CRCHD) Geographic Management of Cancer Health Disparities Program (GMaP) initiated in 2009 brings together investigators, trainees, students, and community health educators to network and share information, scientific resources, and tools to promote cancer and cancer health disparities research, as well as community education outreach within and across regions. To reach their goals, CRCHD initiated 7 GMaP regional “hubs” across the United States to enhance their capacity in areas of disparities research, contribute to the next generation of researchers, and achieve measurable reductions in cancer health disparities. Each hub is led by Regional Coordinating Directors (RCDs) who facilitate connections, provide funding and training resources and “leverage the strengths of its people, programs, and resources to provide greater access to cancer information.” Methods: The GMaP Region 1 North (R1N) hub is based at the Markey Cancer Center in Lexington, Kentucky. R1N partners with Johns Hopkins University's Sidney Kimmel Comprehensive Cancer Center, the University of South Carolina, and the University of Virginia Cancer Center to serve Delaware, Kentucky, Maryland, Maine, New Hampshire, Vermont, Virginia, West Virginia, Washington, DC, and West Virginia. The overall goal of GMaP R1N is to enhance the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to contribute to the reduction of cancer health disparities in the region. As part of the Continuing Umbrella of Research Experiences (CURE) Program, GMaP R1N promotes the F31, K series, and Diversity Supplement funding opportunities to potential applicants. R1N implemented pilot awards and travel scholarships for CURE-eligible candidates; developed a listserv to communicate with researchers, trainees, and potential applicants; and maintains regular contact with trainees to answer questions and encourage applications for NCI CURE Program and other grant opportunities. Results: R1N awarded 11 pilot projects, 22 travel scholarships, helped identify mentors and 146 potential applicants for NCI CURE Program grants, and collaborated with points of contact (POC) at colleges and universities, including Historically Black Colleges and Universities to identify potential applicants for NCI CURE and other funding. Conclusions: Methods have been successful in increasing interest in NCI Cancer health disparities training opportunities. RCDs are critical in establishing and maintaining linkages to support mentor-mentee relationships supported by available funding mechanisms; to engage institutional support for pre- and post-award activities, especially for new investigators; and for shrinking delays in the IRB review and approval process. RCDs have identified process barriers and work with regional POCs to eliminate these barriers and increase efficiencies to further the GMaP mission. Citation Format: Marcela Blinka, Mark Cromo, Julia F. Houston, Mark Dignan, Nathan Vanderford, B. Mark Evers, Janice Bowie, Adrian Dobs, James Hebert, Tisha Felder, Roger Anderson. Results to date: Efforts to increase cancer health disparities training in Geographic Management of Cancer Health Disparities Program Region 1 North [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A068.

Objective: While the incidence of epithelial ovarian cancer (EOC) is lower among African American (AA) women compared with European American (EA) women, AA women have markedly worse outcomes. In this study, we describe individual, social, and societal factors in health-related quality of life (HRQL) in AA women diagnosed with EOC in the African American Cancer Epidemiology Study (AACES) that we hypothesize may influence a patient's capacity to psychosocially adjust to a diagnosis of cancer. Methods: There were 215 invasive EOC cases included in the analysis. HRQL was measured using the SF-8 component scores for physical (PCS) and mental (MCS) health. We used least squares regression to test the effects of individual dispositional factors (optimism and trait anxiety); social level (perceived social support); and societal-level factors (SES defined as low family income and low educational attainment, and perceived discrimination) on HRQL, while adjusting for patient age, tumor stage, body mass index, and comorbidity. Mediation analysis was applied to test whether social support and physical activity buffer impacts of EOC on HRQL. Results: Optimism, trait anxiety, social support, poverty, and past perceived discrimination were significantly associated with HRQL following diagnosis of EOC. Specifically, higher family income, lower phobic anxiety, and higher social support were associated with better wellbeing on the MCS and PCS (p

A study of Pc-5 magnetic pulsations using data from the Combined Release and Radiation Effects Satellite (CRRES) was carried out. Three-component dynamic magnetic field spectrograms have been used to survey ULF pulsation activity for the approximate fourteen month lifetime of CRRES. Two-hour panels of dynamic spectra were examined to find events which fall into two basic categories: 1) toroidal modes (fundamental and harmonic resonances) and 2) poloidal modes, which include compressional oscillations. The occurence rates were determined as a function of L value and local time. The main result is a comparable probability of occurence of toroidal mode oscillations on the dawn and dusk sides of the magnetosphere inside geosynchronous orbit, while poloidal mode oscillations occur predominantly along the dusk side, consistent with high azimuthal mode number excitation by ring current ions. Pc-5 pulsations following Storm Sudden Commencements (SSCs) were examined separately. The spatial distribution of modes for the SSC events was consistent with the statistical study for the lifetime of CRRES. The toroidal fundamental (and harmonic) resonances are the dominant mode seen on the dawn-side of the magnetosphere following SSCs. Power is mixed in all three components. In the 21 dusk side SSC events there were only a few examples of purely compressional (two) or radial (one) power in the CRRES study, a few more examples of purely toroidal modes (six), with all three components predominant in about half (ten) of the events. Key words. Magnetospheric physics (MHD waves and instabilities; magnetospheric configuration and dynamics) – Space plasma physics (waves and instabilities)

This study describes the onset process of auroral substorms in connection with the vertical evolution of auroral particle acceleration, on the basis of auroral kilometric radiation (AKR) dynamics. We show that the auroral acceleration process at substorm onset basically consists of two stages: (1) appearance/intensification of a low-altitude acceleration region at 4000–5000 km accompanied by initial brightening and (2) breakout of high-altitude field-aligned acceleration above the pre-existing low-altitude acceleration region at 6000–12 000 km, which is followed by auroral breakup and poleward expansion. It is also revealed that this two-stage evolution of auroral acceleration corresponds to the two-step reinforcement of field-aligned current.

INTRODUCTION: We sought to identify the role of provider and facility characteristics in receipt of radical prostatectomy (RP) or external beam radiation therapy (EBRT) and adherence to quality of care measures in men with localized prostate cancer (PCa) MATERIALS AND METHODS: Subjects included 2861 and 1630 men treated with RP or EBRT respectively for localized PCa whose records were re-abstracted as part of the Centers for Disease Control and Prevention Breast and Prostate Patterns of Care Study. We utilized multivariable generalized estimating equation (GEE) regression analysis to assess patient, clinical, and provider (year of graduation, urologist density) and facility (group vs. solo, academic/teaching status, for-profit status, distance to treatment facility) characteristics that predicted use of RP versus EBRT as well as quality of care outcomes. RESULTS: Multivariable analysis revealed that Group (vs. solo) practice was associated with a decreased risk of RP (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.25-0.91). Among RP patients with low risk disease, receipt of a bone scan that was not recommended was significantly predicted by race and insurance status. Surgical quality of care measures were associated with physician’s year of graduation and receiving care at a teaching facility. CONCLUSIONS: In addition to demographic factors, we found that provider and facility characteristics were associated with treatment choice and specific quality of care measures. Long term follow-up is required to determine if quality of care indicators are related to prostate cancer outcomes.

PURPOSE The 2-step floating catchment area (2SFCA) method of measuring access to care has never been used to study cancer disparities in Appalachia. First, we evaluated the 2SFCA method in relation to traditional methods. We then examined the impact of access to mammography centers and primary care on late-stage breast cancer diagnosis and receipt of adjuvant hormonal therapy. METHODS Cancer registries from Pennsylvania, Ohio, Kentucky, and North Carolina were linked with Medicare data to identify the stage of breast cancer diagnosis for Appalachia women diagnosed between 2006 and 2008. Women eligible for adjuvant therapy had stage I, II, or III diagnosis; mastectomy or breast-conserving surgery; and hormone receptor-positive breast cancers. Geographically weighted regression was used to explore nonstationarity in the demographic and spatial access predictor variables. RESULTS Over 21% of 15,299 women diagnosed with breast cancer had late-stage (stages III-IV) diagnosis. Predictors included age at diagnosis [odds ratio (OR)=0.86; P

There are wide disparities in breast cancer-specific survival by patient sociodemographic characteristics. Women of lower income, for instance, have higher relapse and death rates from breast cancer. One possible contributing factor for this disparity is low use of adjuvant endocrine therapy-an extremely efficacious therapy in women with early stage, hormone receptor positive breast cancer, the most common subtype of breast cancer. Alone, adjuvant endocrine therapy decreases breast cancer recurrence by 50% and death by 30%. Data suggest that low use of adjuvant endocrine therapy is a potentially important and modifiable risk factor for poor outcome in low-income breast cancer patients.

Background: Disparities exist in breast cancer outcomes by age, geographic location, and socioeconomic status, but there is little data regarding contributing factors to disparities within Appalachia. Underuse of adjuvant endocrine therapy for breast cancer can contribute to disparities. We studied older women within four states of Appalachia and explored adherence and persistence rates for adjuvant endocrine therapy. Methods: The study group consisted of women with stage I-III breast cancer diagnosed 2008-2009 in North Carolina, Pennsylvania, Kentucky, and Georgia, who were continuously enrolled in Part D Medicare and filled a prescription for tamoxifen, anastrozole, letrozole, or exemestane. Adherence rate is defined by medication possession ratio (MPR=sum of days supply for all claims during the calendar year after first prescription). Persistence rate was defined as absence of a 90 day or greater gap in prescription coverage since the first prescription fill. Univariate analyses by Kruskall-Wallis nonparametric test were performed. Variables included age, year of diagnosis, Charlson comorbidity score, Medicaid/Medicare versus Medicare insurance status, rural versus urban residence, county-level economic status (Appalachia Regional Commission: Distressed, At risk, Transitional, or Competitive), state, stage (1, 2A, 2B, or 3), and breast conserving surgery (BCS) versus mastectomy. Results: We identified 726 eligible cases. Mean age was 75.1 years (range 41-98); 97.9% were white; 47.9% had rural residence, 9.5% lived in distressed counties, 29.1% were dual-Medicaid/Medicare insured, mean Charlson comorbidity score was 1.66, and tumor was stage 1 in 56.6%, 2 in 33.6%, and 3 in 9.8%. Mean MPR was 57% (SD 0.27). Persistence rate at 6-months was 79% (SD 0.41) and at 12-months was 36% (SD 0.48). MPR varied significantly within age groups (p=0.01), county-level economic status levels (p=0.01), and Singh Index Area Deprivation tertiles (p=0.01). Mean MPR increased with increasing age: 48% for age 40--65, 55% for age 66-75, 59% for age 76-85, and 63% for age 86 and older. MPR was highest among those in the Competitive ARC class at median levels of 64%, versus 53% in Distressed, 58% in At Risk, and 58% in Transitional. Greatest area deprivation tertile also coincided with lower mean and median MPR adherence. Persistence at 12 months varied significantly among age groups (p=0.01), and type of surgery (p=0.04). Persistence rates were lower in younger cases: 23% for age 40-65, 34% for age 66-75, 37% for age 76-85, and 49% for age 86 and older. Persistence rates were 32% in those who had BCS and 42% in mastectomy. Persistence rates varied significantly among comorbidity levels (p=0.0260); but, after adjusting for age and using logistic regression, this association was only marginally significant (p=0.05). Adjusted expected persistence increased as comorbidity score increased: 28% for 0; 35% for 1; and 39% for 2 or more. Conclusions: Among this group of women within four states in Appalachia with Medicare Part D who filled a prescription for endocrine therapy, overall adherence and persistence rates were low. Higher adherence and persistence rates were seen in older age groups. Citation Format: Gretchen G Kimmick, Fabian Camacho, Roger T Anderson. Rates of adherence and persistence to adjuvant endocrine therapy among women enrolled in Medicare Part D in a four-state region of Appalachia [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-17.

Inspired by recent observations of three cases of coincident ground-level auroral kilometric radiation (AKR)-like signals and outgoing AKR measured with the Geotail satellite, investigation of 2008 data from four Antarctic observatories yields >30 additional examples. The occurrence rate peaks near 22 MLT similar to that of AKR. Polarization measurements of one event show it to be right-hand polarized. Correlation analysis of ground-level and satellite data suggests an imperfect correlation with 2–3 sigma significance, although occasionally much better. (Perfect correlation is not expected, for at least two reasons: distant satellites detect AKR from many sources over a significant part of the oval, and many effects can hinder transmission of AKR from those sources to either distant satellites or ground stations.) Statistical analysis of the existing quantity of data is therefore suggestive but does not prove a connection between the ground-level AKR-like signals and outgoing AKR. However, two other methods provide evidence favoring such a connection. The first full-resolution measurements of ground-level AKR-like signals show that their fine structure strongly resembles that of AKR as known from high-resolution spacecraft receivers. Two case studies show that the location of active aurora, presumed connected with the AKR sources, controls whether or not the ground station detects the AKR, or which of several ground stations detects it most strongly. These investigations strengthen the hypothesis that through some mechanism, sources of outgoing AKR detected by distant satellites occasionally generate signals detectable as whistler mode waves at low altitude or right-hand polarized signals at ground level.

David T Eton,1,2 Jennifer L Ridgeway,1,2 Jason S Egginton,1,2 Kristina Tiedje,3 Mark Linzer,4,5 Deborah H Boehm,4 Sara Poplau,6 Djenane Ramalho de Oliveira,7 Laura Odell,8 Victor M Montori,1,9 Carl R May,10 Roger T Anderson11 1Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; 2Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; 3Department of Sociology and Anthropology, Université Lumière Lyon 2, Lyon, France; 4Division of General Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; 5University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA; 6Minneapolis Medical Research Foundation, Minneapolis, MN, USA; 7Department of Social Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; 8Pharmacy Services, Mayo Clinic, Rochester, MN, USA; 9Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; 10Faculty of Health Sciences and NIHR CLAHRC Wessex, University of Southampton, Southampton, UK; 11School of Medicine, University of Virginia, Charlottesville, VA, USA Purpose: The workload of health care and its impact on patient functioning and well-being is known as treatment burden. The purpose of this study was to finalize a conceptual framework of treatment burden that will be used to inform a new patient-reported measure of this construct. Patients and methods: Semi-structured interviews were conducted with 50 chronically ill patients from a large academic medical center (n=32) and an urban safety-net hospital (n=18). We coded themes identifying treatment burden, with the themes harmonized through discussion between multiple coders. Four focus groups, each with five to eight participants with chronic illness, were subsequently held to confirm the thematic structure that emerged from the interviews. Results: Most interviewed patients (98%) were coping with multiple chronic conditions. A preliminary conceptual framework using data from the first 32 interviews was evaluated and was modified using narrative data from 18 additional interviews with a racially and socioeconomically diverse sample of patients. The final framework features three overarching themes with associated subthemes. These themes included: 1) work patients must do to care for their health (eg, taking medications, keeping medical appointments, monitoring health); 2) challenges/stressors that exacerbate perceived burden (eg, financial, interpersonal, provider obstacles); and 3) impacts of burden (eg, role limitations, mental exhaustion). All themes and subthemes were subsequently confirmed in focus groups. Conclusion: The final conceptual framework can be used as a foundation for building a patient self-report measure to systematically study treatment burden for research and analytical purposes, as well as to promote meaningful clinic-based dialogue between patients and providers about the challenges inherent in maintaining complex self-management of health. Keywords: treatment burden, conceptual framework, adherence, questionnaire, self-management, multi-morbidity

Background: The study was conducted in support of an R01-funded project, “Patterns of Patient Care in Appalachia”. Most counties within Appalachia are designated as medically underserved, have sparse health care resources and lack integrated care systems. This study determined the extent of geographical differences among American Cancer Society (ACS) patient navigation resources (navigator and/or cancer resource center) in Appalachia. Specifically, this study investigated if there were barriers to access to ACS patient navigation for cancer care in the Appalachia region of PA, KY, OH, and NC. Results: Of the cancer care centers and hospitals in the Appalachia region studied, (n=232), web-based data informed that facilities (n=186, 80.0%) did not have ACS patient navigation resources compared to Appalachia cancer care centers and hospitals with ACS PN services = 20%. KY had fewer ACS PN centers (5) compared to PA (20), with Pittsburgh (Allegheny county) containing a noticeable cluster of ACS PN facilities (N = 6 out of 18 total). KY also had the lowest rates (12.5%) of facilities with ACS patient navigators. North Carolina had the highest rate of facilities with ACS patient navigation services compared to OH, KY, and PA (32.2%). The proportion of facilities with ACS PN were proportionately less for facilities located in non-Metropolitan areas (15%) compared to those located in metropolitan areas (26%, chi-square p = 0.0339). Significance: Two overarching results were identified in this study. Firstly, a large number of cancer care centers in the Appalachian region do not have ACS patient navigator services which enable patients to gain individualized assistance, overcome barriers that hinder access to care and access to information about the illness and services available. Secondly, the lack of standards and curriculum for patient navigators indicates there is considerable variation in level of exposure for each patient navigator.

We describe individual, area, and provider characteristics associated with care patterns for early-stage breast cancer in Appalachian counties of Kentucky, North Carolina, Ohio, and Pennsylvania.Cases of stages I to III breast cancer from 2006 to 2008 were linked to Medicare claims occurring within 1 year of diagnosis. Rates of guideline-concordant endocrine therapy (n = 1,429), chemotherapy (n = 1,480), and radiation therapy (RT) after breast-conserving surgery were studied; RT was studied in women age ≥ 70 years with stage I estrogen receptor (ER) -positive/progesterone receptor (PR) -positive cancer, for whom RT was optional (n = 1,108), and in all others, for whom RT was guideline concordant (n = 1,422). Univariable and multivariable analyses were performed. Independent variables included age, race, county-level economic status, state, surgeon graduation year and volume, comorbidity, diagnosis year, Medicaid/Medicare dual status, histology, tumor size, tumor sequence, positive lymph nodes, ER/PR status, stage, trastuzumab use, and surgery type.Population mean age was 74 years; 97% were white. For endocrine therapy, chemotherapy, and RT, guideline concordance was 76%, 48%, and 83%, respectively. Where it was optional, 77% received RT. Guideline-concordant endocrine therapy was lower in North Carolina versus Pennsylvania (odds ratio [OR], 0.60; 95% CI, 0.41 to 0.88) and higher if surgeon graduated between 1984 and 1988 versus ≥ 1989 (OR, 1.58; 95% CI, 1.06 to 2.34). Guideline-concordant chemotherapy varied significantly by state, county-level economic status, and surgeon volume. In guideline-concordant RT, lower surgeon volume (v highest) predicted RT use (OR, 1.63; 95% CI, 1.61 to 2.36). In optional RT, North Carolina residence (v Pennsylvania; OR, 0.29; 95% CI, 0.17 to 0.48) and counties with higher economic status (OR, 0.61; 95% CI, 0.40 to 0.94) predicated RT omission.Notable variation in care by geographic and surgical provider characteristics provides targets for further research in underserved areas.

Introduction Alliaria petiolata, an herbaceous plant, has invaded woodlands in North America. Its ecology has been thoroughly studied, but an overlooked aspect of its biology is seed dispersal distances and mechanisms. We measured seed dispersal distances in the field and tested if epizoochory is a potential mechanism for long-distance seed dispersal. Methods Dispersal distances were measured by placing seed traps in a sector design around three seed point sources, which consisted of 15 second-year plants transplanted within a 0.25 m radius circle. Traps were placed at intervals ranging from 0.25–3.25 m from the point source. Traps remained in the field until a majority of seeds were dispersed. Eight probability density functions were fitted to seed trap counts via maximum likelihood. Epizoochory was tested as a potential seed dispersal mechanism for A. petiolata through a combination of field and laboratory experiments. To test if small mammals transport A. petiolata seeds in their fur, experimental blocks were placed around dense A. petiolata patches. Each block contained a mammal inclusion treatment (MIT) and control. The MIT consisted of a wood-frame (31 × 61× 31 cm) covered in wire mesh, except for the two 31 × 31 cm ends, placed over a germination tray filled with potting soil. A pan filled with bait was placed in the center of the tray. The control frame (11 × 31 × 61 cm) was placed over a germination tray and completely covered in wire mesh to exclude animal activity. Treatments were in the field for peak seed dispersal. In March, trays were moved to a greenhouse and A. petiolata seedlings were counted and then compared between treatments. To determine if A. petiolata seeds attach to raccoon (Procyon lotor) and white-tailed deer (Odocoileus virginianus) fur, wet and dry seeds were dropped onto wet and dry fur. Furs were rotated 180 degrees and the seeds that remained attached were counted. To measure seed retention, seeds were dropped on furs and rotated as before, then the furs were agitated for one hour. The seeds retained in the fur were counted. Results For the seed dispersal experiment, the 2Dt function provided the best fit and was the most biologically meaningful. It predicted that seed density rapidly declined with distance from the point source. Mean dispersal distance was 0.52 m and 95% of seeds dispersed within 1.14 m. The epizoochory field experiment showed increased mammal activity and A. petiolata seedlings in germination trays of the MIT compared to control. Laboratory studies showed 3–26% of seeds were attached and retained by raccoon and deer fur. Retention significantly increased if either seed or fur were wet (57–98%). Discussion Without animal seed vectors, most seeds fall within a short distance of the seed source; however, long distance dispersal may be accomplished by epizoochory. Our data are consistent with A. petiolata’s widespread distribution and development of dense clusters of the species in invaded areas.

To evaluate variations in the use of adjuvant endocrine therapy (AET) by race and geography, this research examined their influence on initiation and adherence to AET in female Medicare enrollees with breast cancer, diagnosed between 2007 and 2011. Using SEER (Surveillance, Epidemiology, and End Results Program)-Medicare data from 2007 to 2001, logistic regressions with random intercept for county of residence were used to predict AET initiation during 1st year and AET adherence assessed by the medication possession ratio (MPR) during year after initiation in a sample of fee-for-service medicare beneficiaries. Part D enrollment was required for the examination of adherence. Independent variables examined were race (black, white, or other) and geographical indicators (area deprivation, non-metropolitan status, and physician shortage). Overall, 23% of patients did not initiate AET within 1 year and 26% of the initiation sample was not adherent to AET, with average follow-up time among initiators of 141 days and an average MPR of 0.84. Significant heterogeneity (P

Mango farmers in Ghana are confronted with many pest problems like fruit flies, Sternochetus mangiferae (F.), and mealy bugs. Different pest management options are available to mango farmers; however, the extent to which they apply the available pest management options is not well known. A survey was conducted among 60 farmers in southeastern Ghana, from October–December 2015 mango season, to find out the level of knowledge and practice of insect pest management used by mango farmers. The results showed that most farmers use conventional insecticides to control insect pests in mango. Majority of the farmers (30%) use a composite insecticide (Cydim super; 36 g cypermethrin + 400 g dimethoate per liter), whereas 3.3% use Pyrinex (chlorpyrifos 480 g/liter). Majority of insecticides used belong to WHO category II. Ninety percent (90%) of the farmers use cultural practices and pheromone traps. Pheromone traps are, however, used for fruit flies but not for S. mangiferae. Over 80% of the respondents who used pesticides to control pests have also adopted GLOBALGAP standards for certification. The results are discussed based on the importance of adoption of IPM strategies in mango production and the possible reduction of fruit rejection during mango export in Ghana.

Purpose To examine local definitive therapy for non-metastatic breast cancer using the Centers for Disease Control and Prevention’s National Program of Cancer Registries Patterns of Care Breast and Prostate Cancer (POCBP) study.

Purpose The objective was to examine the impact of regular primary care encounters (PCE) on early breast cancer detection in an Appalachian sample of Medicare beneficiaries diagnosed 2006-2008. Determinants of PCE were investigated and a mediation analysis was conducted where PCE was a mediator to cancer stage. Methods A total of 3,589 cases were identified from Appalachian areas in Pennsylvania, Kentucky, Ohio, and North Carolina, and health care services were examined 2 months to 2 years prior to diagnosis. A regular care PCE variable was constructed with 4 ordinal levels: none, any, “annual,” and “semi-annual.” Association of PCE with stage, mortality and covariables was conducted using ordinal logistic regressions and Cox Proportional Hazards survival models. Results Sixty-eight percent of the cases had semi-annual PCE. Regular PCE was strongly associated with late-stage cancer rates (39%-13% by increasing PCE level, P < .0001) and 5-year all-cause mortality (42%-24%, P < .0001). Subgroup analysis revealed variations by hypertension and urban status, with nonhypertensives with no PCE being at particularly increased risk. Significant determinants of PCE included age, rural/urban status, comorbidity, dual Medicaid insurance, Appalachian region economic classification, state, select comorbidities, hypertension, and minimum distance to provider. Mediation analysis results were consistent with lower number of comorbidities leading to increased late cancer detection due to patients having a decreased PCE. Conclusion PCE is an important determinant of cancer detection, with a dose-response relationship. Variations exist by geography and hypertension. Comorbidity may influence both PCE and late-stage rates with partial mediation through PCE.

Objectives. We assessed how the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) reporting guideline was used by authors and journal editors in journals’ instructions to authors. We also evaluated its impact on reporting completeness and study quality. Methods. We extracted data from publications that cited TREND on how TREND was used in those reports; we also extracted information on journals’ instructions to authors. We then undertook a case–control study of relevant publications to evaluate the impact of using TREND. Results. Between 2004 and 2013, TREND was cited 412 times, but it was only evidently applied to study reports 47 times. TREND was specifically mentioned 14 times in the sample of 61 instructions to authors. Some evidence suggested that use of TREND was associated with more comprehensive reporting and higher study quality ratings. Conclusions. TREND appeared to be underutilized by authors and journal editors despite its potential application and benefits. We found evidence that suggested that using TREND could contribute to more transparent and complete study reports. Even when authors reported using TREND, reporting completeness was still suboptimal.

Purpose The mortality rate of laryngeal cancer has been trending downward with the use of more effective surgical, radiation, and systemic therapies. Although the best treatment for this disease is not entirely clear, there is a growing consensus on the value of primary radiotherapy as an organ preservation strategy. This study examines urban-rural differences in the use of radiotherapy as the primary treatment for early stage laryngeal cancer in Pennsylvania. Experimental Design The sample was drawn from the Pennsylvania tumor registry, which lists 2,437 laryngeal cancer patients diagnosed from 2001 to 2005. We selected 1,705 adults with early stage squamous cell carcinoma of the larynx for our analysis. Demographic data and tumor characteristics were included as control variables in multivariate analyses. Rurality was assigned by ZIP code of patient residence. Results Controlling for demographic and clinical factors, rural patients were less likely than urban patients to receive radiotherapy as the primary treatment modality for early stage larynx cancer (OR 0.740, 95% CI 0.577-0.949, P = .0087). No other associations between rural status and treatment choice were statistically significant. Conclusions Relatively fewer rural patients with larynx cancer are treated primarily with radiation therapy. Further investigations to describe this interaction more thoroughly, and to see if this observation is found in larger population data sets, are warranted.

An inventory of species diversity of insects of the Muni-Pomadze Ramsar site, with special reference to species of conservation concern, was carried out as part of an evaluation of changes in the ecological character of the site, twenty years after designation. Samples were taken from two protected areas within the Ramsar site, in the wet (July), dry (January), and intermediate (June) seasons. Community diversity was characterized in terms of number of species accumulated, species richness, Shannon-Weiner indices of diversity, Pielou’s evenness, and Bray-Curtis similarity. A total of 134 families from 19 insect orders were recorded during the entire study period. Yenku Block A recorded the highest species richness (98) and the highest diversity index (14.97), corroborated by the highest Margalef index of 3.82 with a relatively even distribution of species (0.834) during the intermediate season, and recorded the lowest diversity (6.957) and species richness (41) during the dry season. On the whole, the Muni-Pomadzi Ramsar site showed a high diversity of insect species. The presence of species such as Junonia oenone and Papilio demodocus which are specialized in degraded habitats at Yenku Block A in large numbers is a clear indication of degradation of the forest, but the presence of forest species such as Salamis anacardii and Euphaedra crokeri is an indication that some parts of this reserve are still in good shape. A comparison of the butterfly species recorded with findings in a 1997 survey showed a marked increase in numbers from 75 to 130; this may be attributed to the habitat changes that have taken place at the site offering more diverse habitat types.

Objectives: To explore the relationship between level and type of comorbidity and guideline-concordant care for early-stage breast cancer. Design: Cross-sectional. Setting: National Program of Cancer Registry (NPCR) Breast and Prostate Cancer Patterns of Care study, which re-abstracted medical records from 2004 in seven cancer registries. Participants: Individuals with stage 0�III breast cancer. Measurements: Multicomponent guideline-concordant management was modeled based on tumor size, node status, and hormone receptor status, according to consensus guidelines. Comorbid conditions and severity were measured using the Adult Comorbidity Evaluation Index (ACE-27). Multivariate logistic regression models determined factors associated with guideline-concordant care and included overall ACE-27 scores and 26 separate ACE comorbidity categories, age, race, stage, and source of payment. Results: The study sample included 6,439 women (mean age 58.7, range 20�99; 76% white; 44% with no comorbidity; 70% estrogen- or progesterone-receptor positive, or both; 31% human epidermal growth factor receptor 2 positive). Care was guideline concordant in 60%. Guideline concordance varied according to overall comorbidity burden (70% for none; 61% for minor; 58% for moderate, 43% for severe; P < .05). In multivariate analysis, the presence of hypertension (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.01�1.30) predicted guideline concordance, whereas dementia (OR = 0.45, 95% CI = 0.24�0.82) predicted lack of guideline concordance. Older age (?50) and black race were associated with less guideline concordance, regardless of comorbidity level. Conclusion: When reporting survival outcomes in individuals with breast cancer with comorbidity, adherence to care guidelines should be among the covariates.

Invasive plants can have strong impacts on native communities, which have prompted intense efforts at invasive removal. However, relatively little is known about how native communities will reassemble after a dominant invader has been removed from the system. Legacy effects of invasive plants on soil microbial communities may alter native plant community reassembly long after the invader is gone. Here we found that arbuscular mycorrhizal fungal (AMF) communities have shown some recovery in experimental plots following 6 years of removal of the invasive Alliaria petiolata (garlic mustard, a species known to degrade AMF communities) in terms of taxonomic richness and community composition. However, despite this recovery, the density of A. petiolata at the beginning of the experiment (in 2004) still correlated with lower AMF richness and altered community composition after 6 years of annual weeding, suggesting long-term legacies of dense A. petiolata infestations. Because native plant and mycorrhizal fungal communities may show interdependence, reassembly of one community may be limited by the reassembly of the other. Restoration may be more effective if practices address both communities simultaneously.

Kogyae Strict Nature Reserve, the only one in Ghana, was established to promote scientific research, particularly on how nature revitalizes itself after major disasters, and also to check the southward drift of the savannah grassland. This study presents the first comprehensive inventory of species composition and diversity of insects of the Reserve. Insects were surveyed between September 2011 and June 2012 to capture the end of the rainy season, the dry season and the peak of the wet season. Samples were taken from two sites within the Reserve, Dagomba and Oku using various sampling techniques including pitfall traps, malaise traps and sweep nets. Insect communities were characterized in terms of, 1) species richness estimators, 2) species richness, 3) Shannon-Weiner Index of Diversity, 4) Pielou’s evenness and 5) Bray-Curtis similarity. A total of 8147 individuals representing 135 families from 21 orders were recorded. This included 107 species of butterflies from 9 families and 20 species of dragonflies from 3 families. Oku recorded the highest species numbers (S = 63) and richness (d = 12.16) with a high evenness of species (J = 0.9377) during the peak of the wet season; and the lowest species numbers (S = 58) and Margalef’s index of (d = 10.14) in January. The highest Shannon diversity index of (H = 3.927) was recorded at Dagomba in January.

Purpose We provide a proof of concept for the detailed characterization of retinal capillary features and surrounding photoreceptor mosaic using a customized nonadaptive optics angiography imaging system. Methods High-resolution fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) images were obtained using a modified Heidelberg retina angiograph (HRA2) device with a reduced scan angle enabling 3° field of view. Colocalized images of the photoreceptor mosaic also were captured in vivo using the same instrument. Visibility of vascular subbranches were compared between high-resolution images and conventional fundus angiography (FA) with a 30° field of view. Results High-resolution angiographic and infrared images (3° × 3° field of view, a 10-fold magnification) were obtained in 10 participants. These included seven patients with various retinal diseases, including myopic degeneration, diabetic retinopathy, macular telangiectasia, and central serous chorioretinopathy, as well as three healthy controls. Images of the retinal vasculature down to the capillary level were obtained on angiography with the ability to visualize a mean 1.2 levels more subbranches compared to conventional FA. In addition, imaging of the photoreceptor cone mosaic, to a sufficient resolution to calculate cone density, was possible. Movement of blood cells within the vasculature also was discernible on infrared videography. Conclusions This exploratory study demonstrates that fast high-resolution angiography and cone visualization is feasible using a commercially available imaging system. Translational relevance This offers potential to better understand the relationship between the retinal neurovascular system in health and disease and the timing of therapeutic interventions in disease states.

Background: Although there are known to be disparities by socioeconomic status (SES) in breast cancer presentation, this has not been as well studied in the elderly. We examined older women in North Carolina (NC) using insurance status as an indicator of SES. Dual Medicaid/Medicare (dMM) status was used as a surrogate for low SES and Medicare only (M) as a surrogate for higher SES. Methods: From the 1999-2002 NC Central Cancer Registry, we identified women age ≥65 years presenting with nonmetastatic breast cancer, having surgery within 60 days of diagnosis, no neoadjuvant therapy, and insured by Medicare only or dual Medicaid/Medicare. We used Chi-square tests to compare demographic and tumor characteristics, including: age, race, ACE comorbidity index, tumor size, lymph node status (LN), ER/PR status and HER2 status. Results: We identified n = 3088 women with mean age 75 (SD 6.69) years, including 560 dMM and 2528 M insured women. We found that the dMM patients were older than M patients, with 57.7% ≥75 years, vs. 42.6% (p Conclusions: We found that in a population of elderly breast cancer patients, lower SES as defined by Medicaid insurance status was associated with older age, African American race and more advanced comorbidity. These same patients presented with move advanced disease, characterized by larger tumors and more LN involvement. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-10.

Background: Lower SES is associated with worse breast cancer outcomes in general. Disparities by SES have not been well studied in older cancer patients. Here, we examined differences in presentation and treatment patterns by SES in older cancer patients. Methods: The NPCR's Patterns of Care study reabstracted the medical records of breast cancer cases diagnosed in 2004 from 7 state cancer registries. For this study, we included women ≥65 years old with stage 0-III breast cancer. SES was defined by insurance status: non-poor if Medicare (M) or poor if Medicare plus Medicaid (dMM). Receipt of adjuvant chemotherapy, radiation (RT) after breast conserving surgery (BCS), and endocrine therapy were compared by insurance status. We used multiple logistic regression to evaluate the role of age, race, comorbidity and tumor characteristics in the differences in receipt of treatment components, both in separate models by insurance status and then in a pooled model that included insurance status as a predictor. Results: Included were 1,844 women, with insurance status M in 1,585 and dMM in 259. Patients with dMM (vs M) were more likely nonwhite (38.1% vs 10.1%, p Conclusions: Despite presenting with higher stage and larger tumors, older breast cancer patients with dual-Medicare-Medicaid insurance were less likely than those with Medicare-only to receive adjuvant chemotherapy, controlling for age, race, comorbidity and tumor characteristics. Research is needed to further explore the disparity in adjuvant chemotherapy use among poor older patients. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-05.

Operations planning in smart grids is likely to become a more complex and demanding task in the next decades. In this paper we show how to formulate the problem of planning short-term load curtailment in a dense urban area, in the presence of uncertainty in electricity demand and in the state of the distribution grid, as a stochastic mixed-integer optimization problem. We propose three rolling-horizon look-ahead policies to approximately solve the optimization problem: a deterministic one and two based on approximate dynamic programming (ADP) techniques. We demonstrate through numerical experiments that the ADP-based policies yield curtailment plans that are more robust on average than the deterministic policy, but at the expense of the additional computational burden needed to calibrate the ADP-based policies. We also show how the worst case performance of the three approximation policies compares with a baseline policy where all curtailable loads are curtailed to the maximum amount possible.

To model the relationship of an area-based measure of a breast cancer screening and geographic area deprivation on the incidence of later stage breast cancer (LSBC) across a diverse region of Appalachia.Central cancer registry data (2006-2008) from three Appalachian states were linked to Medicare claims and census data.Exploratory spatial analysis preceded the statistical model based on negative binomial regression to model predictors and effect modification by geographic subregions.Exploratory spatial analysis revealed geographically varying effects of area deprivation and screening on LSBC. In the negative binomial regression model, predictors of LSBC included receipt of screening, area deprivation, supply of mammography centers, and female population aged75 years. The most deprived counties had a 3.31 times greater rate of LSBC compared to the least deprived. Effect of screening on LSBC was significantly stronger in northern Appalachia than elsewhere in the study region, found mostly for high-population counties.Breast cancer screening and area deprivation are strongly associated with disparity in LBSC in Appalachia. The presence of geographically varying predictors of later stage tumors in Appalachia suggests the importance of place-based health care access and risk.

Background Despite growing utilization of accelerated partial breast irradiation using brachytherapy (APBI-Brachy) for elderly breast cancer patients, there are limited data from randomized Phase III trials to support its routine use. This study uses population-based data to examine whether APBI-Brachy results in comparable survival rates compared with whole breast irradiation (WBI). Methods A sample of 29,647 female patients diagnosed with nonmetastatic breast cancer in 2002–2007 treated with breast-conserving surgery and radiotherapy was identified in the Surveillance, Epidemiology, and End Results Program-Medicare data set. Log-rank tests, Cox proportional hazards models, instrumental variable analysis, and subgroup analysis were used to study the comparative effectiveness of APBI-Brachy and WBI. Results During a median followup of 3.6 and 4.8 years, 123 (7.7%) and 3438 (13.6%) patients died after APBI-Brachy and WBI, respectively. Recurrence-free survival ( p = 0.9711) and overall survival rates ( p = 0.0551) did not differ significantly between the two radiation modalities. After accounting for tumor characteristics, patient characteristics, community factors, and comorbidities, the recurrence-free survival (hazard ratio, 1.05; 95% confidence interval, 0.90–1.23; p = 0.5125) and overall survival (hazard ratio, 0.87; 95% confidence interval, 0.72–1.04; p = 0.1332) rates were still not significantly different between patients treated with APBI-Brachy and WBI. Conclusion Partial breast brachytherapy and WBI resulted in similar recurrence-free and overall survival rates in this cohort of elderly breast cancer patients, even after adjustment for the more favorable characteristics of patients in the former group. These findings will need to be confirmed by the randomized trials comparing these modalities.

Thyroid cancer is the most common endocrine malignancy, with differentiated thyroid cancer (DTC) comprising ~93% of all thyroid cancers. While most cases of DTC are curable with the use of surgery and radioactive iodine (RAI) ablation of the remaining thyroid remnant, prognosis is dire and treatment options limited when DTC becomes RAI-refractory (RAI-R). Standard cytotoxic chemotherapy has limited efficacy, making enrollment in clinical trials of novel targeted therapies the preferred treatment approach. Thus, we conducted a comprehensive systematic review of the clinical trial scientific literature with a focus on efficacy, safety, and economics to identify all potential treatment options that have been or are currently being evaluated for the treatment of RAI-R DTC.Embase.com (including Medline), Medline In-Process and other nonindexed citations, the Cochrane Libraries, ClinicalTrials.gov, and relevant recent conference proceedings were searched using predefined search criteria. Important inclusion criteria included English language, randomized controlled studies or interventional single-arm studies only, and studies of drug therapies only. Search results were screened utilizing the discretion of multiple researchers, and key data were abstracted.Forty-five unique trials (16 full-text, 4 conference abstracts, and 25 ClinicalTrials.gov entries) were included in the clinical review. No studies that met criteria for inclusion in the economic review were identified. Among 20 trials with results available, all were Phase II and only one was randomized. The most commonly studied drugs were tyrosine kinase inhibitors (TKIs); other drugs included celecoxib, doxorubicin with interferon alpha-2b, rosiglitazone, selumetinib (AZD6244), thalidomide, VEGF trap, and vorinostat. Overall, efficacy and safety profiles were specific to treatment regimen, with objective response rates (ORR) ranging from 0% on gefitinib, rosiglitazone, VEGF trap, and vorinostat to 50% on lenvatinib, a TKI.Limited clinical research and no economic research has been conducted in RAI-R DTC. Certain treatments, notably TKIs, have shown promise in Phase II trials, and two Phase III randomized placebo-controlled trials are ongoing. New research on the economic and humanistic burden of RAI-R DTC must be paired with the clinical evidence currently in development to examine the existing burden and future promise in treating patients with RAI-R DTC.

To examine the relationship between radiation therapy resources and guideline-concordant radiotherapy after breast-conserving surgery (BCS) in Kentucky.The SEER registry and Area Resource File provided county-level data describing cancer care resources and socioeconomic conditions of Kentucky residents.The outcome variable was rate of BCS without radiotherapy in each county for 2000-2007. Eight-year weighted average rates of radiation therapy providers and hospitals per 100,000 residents were explanatory variables of interest. Exploratory spatial data analyses and spatial econometric models were estimated.Appalachian counties in Kentucky had significantly fewer radiation oncologists, hospitals with radiation therapy facilities, and surgeons per 100,000 residents than non-Appalachian counties. The likelihood of BCS without radiation was significantly higher among Appalachian compared to non-Appalachian women (42.5 percent vs. 29.0 percent, p .001). Higher proportions of women not receiving recommended radiotherapy after BCS were clustered in Eastern Kentucky around Lexington. This geographic disparity was partially explained by significantly fewer radiation therapy facilities in Appalachian Kentucky in adjusted analyses.Scarce radiation therapy resources in Appalachian Kentucky are associated with disparities in receipt of guideline-concordant radiotherapy, suggesting that policy action is needed to improve the cancer treatment infrastructure in disadvantaged mountainous areas.

Purpose: The area of complete spatial summation (Ricco’s area) for achromatic stimuli has previously been shown to decrease with increased background luminance. A popular hypothesis is that such a phenomenon reflects increased center-surround antagonism within the receptive field of the retinal ganglion cell. We wished to investigate if similar changes in Ricco’s area occur with blue background luminance for the S-cone pathway, guided by the knowledge that the retinal ganglion cells with S-cone input do not display S-cone–mediated center-surround antagonism (S+/S-).\ud \ud Methods: Spatial summation functions were measured for four young healthy observers under S-cone pathway isolation by presenting blue test stimuli on a background consisting of intense fixed yellow (600 cd/m2) component in combination with a variable blue component (background range, 1.78 to 2.82 log S-Td). Ricco’s area was estimated by two-phase regression analysis.\ud \ud Results: All subjects demonstrated a notable decrease in Ricco’s area with increasing blue background luminance. On average, Ricco’s area decreased in size by 0.39 log units per log unit increase in blue background luminance.\ud \ud Conclusions: The change in Ricco’s area with the blue background component is not what one would initially expect given the known organization of S-cone–driven cells at the retinal level. Spatial reorganization by the suppressive surround of the receptive fields at a cortical level and a reduction in the contribution from S-cones with the lowest weights in the retinal receptive field periphery are among the possible mechanisms of the summation changes observed. These findings have implications for the design of clinical tests of the S-cone pathway.

Purpose To determine the impact of longer periods between biopsy-confirmed breast cancer diagnosis and the initiation of treatment (Dx2Tx) on survival. Patients and Methods This study was a noninterventional, retrospective analysis of adult female North Carolina Medicaid enrollees diagnosed with breast cancer from January 1, 2000, through December, 31, 2002, in the linked North Carolina Central Cancer Registry–Medicaid Claims database. Follow-up data were available through July 31, 2006. Cox proportional hazards regression models were constructed to evaluate the impact on survival of delaying treatment ≥ 60 days after a confirmed diagnosis of breast cancer. Results The study cohort consisted of 1,786 low-income, adult women with a mean age of 61.6 years. A large proportion of the patients (44.3%) were racial minorities. Median time from biopsy-confirmed diagnosis to treatment initiation was 22 days. Adjusted Cox proportional hazards regression showed that although Dx2Tx length did not affect survival among those diagnosed at early stage, among late-stage patients, intervals between diagnosis and first treatment ≥ 60 days were associated with significantly worse overall survival (hazard ratio [HR], 1.66; 95% CI, 1.00 to 2.77; P = .05) and breast cancer–specific survival (HR, 1.85; 95% CI, 1.04 to 3.27; P = .04). Conclusion One in 10 women waited ≥ 60 days to initiate treatment after a diagnosis of breast cancer. Waiting ≥ 60 days to initiate treatment was associated with a significant 66% and 85% increased risk of overall and breast cancer–related death, respectively, among late-stage patients. Interventions designed to increase the timeliness of receiving breast cancer treatments should target late-stage patients, and clinicians should strive to promptly triage and initiate treatment for patients diagnosed at late stage.

PURPOSE: The purpose of this study was to develop and validate a new comprehensive patient-reported measure of treatment burden-the Patient Experience with Treatment and Self-management (PETS). METHODS: A conceptual framework was used to derive the PETS with items reviewed and cognitively tested with patients. A survey battery, including a pilot version of the PETS, was mailed to 838 multi-morbid patients from two healthcare institutions for validation. RESULTS: A total of 332 multi-morbid patients returned completed surveys. Diagnostics supported deletion and consolidation of some items and domains. Confirmatory factor analysis supported a domain model for scaling comprised of 9 factors: medical information, medications, medical appointments, monitoring health, interpersonal challenges, medical/healthcare expenses, difficulty with healthcare services, role/social activity limitations, and physical/mental exhaustion. Scales showed good internal consistency (α range 0.79-0.95). Higher PETS scores, indicative of greater treatment burden, were correlated with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare (Ps

Introduction Cancer has become the leading cause of death in China. Several knowledge gaps exist with respect to the patterns of cancer care and disparities in China. Chinese healthcare researchers do not have access to cancer research data of high quality. Only cancer incidence and mortality rates have been analysed in China while the patterns of cancer screening and treatment and disparities have not been rigorously examined. Potential disparities in cancer care by socioeconomic status have not been analysed in the previous literature. Population-based estimates of cancer care costs remain unexamined in China. This project will depict the pattern of cancer screening, incidence and treatment in Shandong province and enhance our understanding of causes of disparities in cancer control. Methods and analysis We will create the first linked database of cancer registry and health insurance claims in China. We obtained cancer registry data on breast, gastrointestinal and lung cancer incidence from 2011 to 2014 and their health insurance claims information from 6 cities/counties of 10.63 million population and validated it with hospital discharge data. A 1600 participant survey will be administered to collect additional information of patients’ socioeconomic status, employment and cancer care costs. Frequency analysis, spatial data exploratory analysis, multivariate logistic regression with instrumental variable, generalised linear regression and subgroup analysis will be used to analyse the following: the receipt of cancer screening, stage at diagnosis, guideline-concordant treatment and cancer care costs. Patient characteristics, tumour features, hospital characteristics, patient comorbidities and county-level descriptors will be used as covariates in the multivariate analysis. Ethics and dissemination The Institutional Review Board of the School of Public Health of Shandong University approved this study (20140201). Data compiled from this project will be made available to all Chinese healthcare researchers. Study results will be disseminated through peer-reviewed publications and presentations at national and international meetings.

Purpose Considerable between-individual variation in retinal ganglion cell (RGC) density exists in healthy individuals, making identification of change from normal to glaucoma difficult. In ascertaining local cone-to-RGC density ratios in healthy individuals, we wished to investigate the usefulness of objective cone density estimates as a surrogate of baseline RGC density in glaucoma patients, and thus a more efficient way of identifying early changes. Design Exploratory cohort study. Participants Twenty glaucoma patients (60% women) with a median age of 54 years and mean deviation (MD) in the visual field of –5 dB and 20 healthy controls (70% women) with a median age of 57 years and a mean MD of 0 dB were included. Methods Glaucoma patients and healthy participants underwent in vivo cone imaging at 4 locations of 8.8° eccentricity with a modified Heidelberg Retina Angiograph HRA2 (scan angle, 3°). Cones were counted using an automated program. Retinal ganglion cell density was estimated at the same test locations from peripheral grating resolution acuity thresholds. Main Outcome Measures Retinal cone density, estimated RGC density, and cone-to-RGC ratios in glaucoma patients and healthy controls. Results Median cone-to-RGC density was 3.51:1 (interquartile range [IQR], 2.59:1–6.81:1) in glaucoma patients compared with 2.35:1 (IQR, 1.83:1–2.82:1) in healthy participants. Retinal ganglion cell density was 33% lower in glaucoma patients than in healthy participants; however, cone density was very similar in glaucoma patients (7248 cells/mm2) and healthy controls (7242 cells/mm2). The area under the receiver operator characteristic curve was 0.79 (95% confidence interval [CI], 0.71–0.86) for both RGC density and cone-to-RGC ratio and 0.49 (95% CI, 0.39–0.58) for cone density. Conclusions Local measurements of cone density do not differ significantly from normal in glaucoma patients despite large differences in RGC density. There was no statistically significant association between RGC density and cone density in the normal participants, and the range of cone-to-RGC density ratios was relatively large in healthy controls. These findings suggest that estimates of baseline RGC density from cone density are unlikely to be precise and offer little advantage over determination of RGC alone in the identification of early glaucomatous change.

Despite being generally accepted that delays in diagnosing breast cancer are of prognostic and psychological concern, the influence of hospital characteristics on such delays remains poorly understood, especially in rural and underserved areas. However, hospital characteristics have been tied to greater efficiency and warrant further investigation as they may have implications for breast cancer care in these areas.Study data were derived from the Kentucky, North Carolina, Ohio, and Pennsylvania state central cancer registries (2006-2008). We then linked Medicare enrollment files and claims data (2005-2009), the Area Resource File (2006-2008), and the American Hospital Association Annual Survey of Hospitals (2007) to create an integrated data set. Hierarchical linear modeling was used to regress the natural log of breast cancer diagnosis delay on a number of hospital-level, demographic, and clinical characteristics.The baseline study sample consisted of 4,547 breast cancer patients enrolled in Medicare that lived in Appalachian counties at the time of diagnosis. We found that hospitals with for-profit ownership (P.01) had shorter diagnosis delays than their counterparts. Estimates for comprehensive oncology services, system membership and size were not statistically significant at conventional levels.Some structural characteristics of hospitals (eg, for-profit ownership) in the Appalachian region are associated with having shorter delays in diagnosing breast cancer. Researchers and practitioners must go beyond examining patient-level demographic and tumor characteristics to better understand the drivers of timely cancer diagnosis, especially in rural and underserved areas.

Background Appalachia is a largely rural, mountainous, poor and underserved region of the United States. Adherence to adjuvant endocrine therapy among Appalachian women with breast cancer is suboptimal. Objectives To explore small-area geographic variations and clustering patterns of breast cancer patient adherence to adjuvant endocrine therapy and associated factors in Appalachia. Methods In this retrospective study, we analyzed Medicare claims data linked with cancer registries from four Appalachian states (PA, OH, KY, and NC) in 2006–2008. We included adult women who were diagnosed with stage I–III, hormone-receptor positive, primary breast cancer and who newly started adjuvant endocrine therapy after the primary treatment for breast cancer. Hot spot analysis was conducted to explore geographic variations in adjuvant endocrine therapy adherence. Geographically weighted logistic regression (GWLR) was used to examine whether the impacts of factors associated with adherence varied across the region. Results Breast cancer patients living in PA and OH showed higher adherence to adjuvant endocrine therapy than those living in KY and NC. We identified clusters of high adherence in most of PA but poor adherence in Erie County, PA and in Buncombe, Transylvania, Henderson, and Polk Counties, NC. Adherence to adjuvant endocrine therapy was significantly associated with the Health Professional Shortage Area designation, catastrophic coverage, dual-eligibility status of Medicaid and Medicare, adjuvant endocrine therapy drug class, and side effects. And among these factors, the impacts of dual-eligibility status and the use of pain medications to treat side effects on adherence were more pronounced in KY and NC than in PA. Conclusions There were significant geographic disparities in adherence to adjuvant endocrine therapy in the Appalachian counties in PA, OH, KY, and NC. This study explored these geographic areas with poor adherence as well as geographically varying effects of predictors on adherence; our results may provide more localized information that may be used to improve adjuvant therapy use and breast cancer care in these high-risk and underserved areas.

Purpose: The goal of this research was to examine spatial access to primary care physicians in Appalachia using both traditional access measures and the 2-step floating catchment area (2SFCA) method. Spatial access to care was compared between urban and rural regions of Appalachia. Methods: The study region included Appalachia counties of Pennsylvania, Ohio, Kentucky, and North Carolina. Primary care physicians during 2008 and total census block group populations were geocoded into GIS software. Ratios of county physicians to population, driving time to nearest primary care physician, and various 2SFCA approaches were compared. Results: Urban areas of the study region had shorter travel times to their closest primary care physician. Provider to population ratios produced results that varied widely from one county to another because of strict geographic boundaries. The 2SFCA method produced varied results depending on the distance decay weight and variable catchment size techniques chose. 2SFCA scores showed greater access to care in urban areas of Pennsylvania, Ohio, and North Carolina. Conclusion: The different parameters of the 2SFCA method—distance decay weights and variable catchment sizes—have a large impact on the resulting spatial access to primary care scores. The findings of this study suggest that using a relative 2SFCA approach, the spatial access ratio method, when detailed patient travel data are unavailable. The 2SFCA method shows promise for measuring access to care in Appalachia, but more research on patient travel preferences is needed to inform implementation.

PurposeInflammatory breast cancer (IBC) is an aggressive subtype of breast cancer for which treatments vary, so we sought to identify factors that affect the receipt of guideline-concordant care.MethodsPatients diagnosed with IBC in 2004 were identified from the Breast and Prostate Cancer Data Quality and Patterns of Care Study, containing information from cancer registries in seven states. Variation in guideline-concordant care for IBC, based on National Comprehensive Cancer Network (NCCN) guidelines, was assessed according to patient, physician, and hospital characteristics.ResultsOf the 107 IBC patients in the study without distant metastasis at the time of diagnosis, only 25.8% received treatment concordant with guidelines. Predictors of non-concordance included patient age (≥70 years), non-white race, normal body mass index (BMI 18.5-25 kg/m(2)), patients with physicians graduating from medical school >15 years prior, and smaller hospital size (

Physarum polycephalum is a well-studied microbial eukaryote with unique experimental attributes relative to other experimental\ud model organisms. It has a sophisticated life cycle with several distinct stages including amoebal, flagellated, and plasmodial cells. It is\ud unusual in switching between open and closed mitosis according to specific life-cycle stages. Here we present the analysis of the\ud genome of this enigmatic and important model organism and compare it with closely related species. The genome is littered with\ud simple and complex repeats and the coding regions are frequently interrupted by introns with a mean size of 100 bases.\ud Complemented with extensive transcriptome data, we define approximately 31,000 gene loci, providing unexpected insights into\ud earlyeukaryoteevolution.Wedescribeextensiveuseofhistidinekinase-basedtwo-componentsystemsandtyrosinekinasesignaling,\ud the presence of bacterial and plant type photoreceptors (phytochromes, cryptochrome, and phototropin) and of plant-type pentatricopeptide\ud repeat proteins, as well as metabolic pathways, and a cell cycle control system typically found in more complex eukaryotes.\ud Our analysis characterizes P. polycephalum as a prototypical eukaryote with features attributed to the last common ancestor of\ud Amorphea, that is, the Amoebozoa and Opisthokonts. Specifically, the presence of tyrosine kinases inAcanthamoeba and Physarum\ud as representatives of two distantly related subdivisions ofAmoebozoa argues against the later emergence of tyrosine kinase signaling\ud in the opisthokont lineage and also against the acquisition by horizontal gene transfer