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Background: Food insecurity is associated with poor health outcomes; however, the connection with cancer care is not well understood. This study aimed to evaluate the impact of county-level food insecurity on the surgical management and survival of patients with esophageal cancer. Methods: Patients with stage I to III esophageal cancer were identified from Surveillance Epidemiology and End Results data (2010-2016). County-level food insecurity rates were obtained from the Map the Meal Gap data (2010-2016), divided into quartiles: high, marginal, low, and very low. Multivariable and multinomial logistic regression analyses were used to examine the relationship between food insecurity and surgical intervention and the relationship between food insecurity and recommendation and receipt of surgery, respectively. Multivariable Cox proportional hazards modeling was used to evaluate 5-year cancer-specific survival. Results: A total of 11,114 patients were identified, most of whom were male (78.8%) and non-Hispanic White (77.7%); 44.8% had stage III disease. The odds of undergoing surgical intervention were 27% lower among patients in high–food insecurity counties compared with very low–food insecurity counties (odds ratio, 0.73; 95% CI, 0.64-0.82). The odds of a patient’s being recommended surgery but not undergoing it was 38% higher among patients in high–food insecurity counties compared with very low–food insecurity counties (odds ratio, 1.38; 95% CI, 1.08-1.75). Patients in higher–food insecurity counties had worse survival when compared with patients in very low–food insecurity counties (high: hazard ratio, 1.26; 95% CI, 1.16-1.36). Conclusions: Among patients with esophageal cancer, significant disparities in surgical resection and survival are associated with high county-level food insecurity. Interventions focused on these communities may help reduce inequities in esophageal cancer care.

Objective: We sought to quantify the influence that tracheostomy placement has on the hemodynamic stability of postoperative cardiac surgery patients with persistent ventilatory requirements. Methods: A retrospective, single-center, and observational analysis of postoperative cardiac surgery patients with prolonged mechanical ventilation who underwent tracheostomy placement from 2018 to 2022 was conducted. Patients were excluded if receiving mechanical circulatory support or if they had an unrelated significant complication 3 days surrounding tracheostomy placement. Vasoactive and inotropic requirements were quantified using the Vasoactive-Inotrope Score. Results: Sixty-one patients were identified, of whom 58 met inclusion criteria. The median vasoactive-inotrope score over the 3 days before tracheostomy compared with 3 days after decreased from 3.35 days (interquartile range, 0-8.79) to 0 days (interquartile range, 0-7.79 days) (P = .027). Graphic representation of this trend demonstrates a clear inflection point at the time of tracheostomy. Also, after tracheostomy placement, fewer patients were on vasoactive/inotropic infusions (67.2% [n = 39] pre vs 24.1% [n = 14] post; P

The objective of this study was to evaluate the overall survival of patients with ≤8 mm non-small cell lung cancer (NSCLC) who undergo wedge resection versus stereotactic body radiation therapy (SBRT). Kaplan–Meier analysis, multivariable Cox proportional hazards modeling, and propensity score-matched analysis were performed to evaluate the overall survival of patients with ≤8 mm NSCLC in the National Cancer Database (NCDB) from 2004 to 2017 who underwent wedge resection versus patients who underwent SBRT. The above-mentioned matched analyses were repeated for patients with no comorbidities. Patients who were coded in the NCDB as having undergone radiation because surgery was contraindicated due to patient risk factors (e.g., comorbid conditions, advance age, etc.) and those with a history of prior malignancy were excluded from analysis. Of the 1505 patients who had NSCLC ≤8 mm during the study period, 1339 (89%) patients underwent wedge resection, and 166 (11%) patients underwent SBRT. In the unadjusted analysis, multivariable Cox modeling and propensity score-matched analysis, wedge resection was associated with improved survival when compared to SBRT. These results were consistent in a sensitivity analysis limited to patients with no comorbidities.

Objective: Retrospective exposure to a higher number and prolonged duration of climate-related disasters could be positively associated with adolescent mental distress. Methods: Person-level data came from 38,616 high-school students residing in 22 urban public-school districts in 14 states (U.S. Youth Risk Behavior Survey, 2019). Each district’s federally declared climate-related catastrophes (severe storms, floods, wildfire, etc.) came from the Federal Emergency Management Agency. Logistic regression models estimated the adjusted odds ratios (aOR) of adolescent mental distress (MD, using survey responses feeling prolonged sadness/ hopelessness and short sleep duration) according to disaster events and days during three exposure periods (past 2-, 5-, 10-years); adjusted for age, gender, race/ethnicity, socio-economic disadvantage, feeling unsafe at school, district area size, district poverty, and region. Results: Over 10 years, the median number of disaster events was 3 and total disaster days was 64. Adolescents experiencing the highest number of disaster days (top quartile vs. less) had 25% higher odds of MD when exposed within the past 2-years (aOR 1.25 [95% CI 1.14, 1.38]), and 20% higher odds of MD when exposed within the past 5-years (aOR 1.20 95% CI 1.07, 1.35). The odds of MD were not statistically associated with exposure periods that extended to 10 years, nor disaster events (instead of disaster days, all p-values > 0.1). Conclusions: Severe weather will become more frequent and last longer with human-induced climate warming. More studies like this are needed to understand the broad range of adverse effects and enhance planning and preparedness including preparing for worsening mental health among adolescents.

IntroductionResearch examining the influence of neighborhood healthy food environment on diet has been mostly cross-sectional and has lacked robust characterization of the food environment. We examined longitudinal associations between features of the local food environment and healthy diet, and whether associations were modified by race/ethnicity.MethodsData on 3634 adults aged 45-84 followed for 10 years were obtained from the Multi-Ethnic Study of Atherosclerosis. Diet quality was assessed using the Alternative Healthy Eating Index at Exam 1 (2000-2002) and Exam 5 (2010-2012). We assessed four measures of the local food environment using survey-based measures (e.g. perceptions of healthier food availability) and geographic information system (GIS)-based measures (e.g. distance to and density of healthier food stores) at Exam 1 and Exam 5. Random effects models adjusted for age, sex, education, moving status, per capita adjusted income, and neighborhood socioeconomic status, and used interaction terms to assess effect measure modification by race/ethnicity.ResultsNet of confounders, one standard z-score higher average composite local food environment was associated with higher average AHEI diet score (β=1.39, 95% CI: 1.05, 1.73) over the follow-up period from Exam 1 to 5. This pattern of association was consistent across both GIS-based and survey-based measures of local food environment and was more pronounced among minoritized racial/ethnic groups. There was no association between changes in neighborhood environment and change in AHEI score, or effect measure modification by race/ethnicity.ConclusionOur findings suggest that neighborhood-level food environment is associated with better diet quality, especially among racially/ethnically minoritized populations.

Background: A significant number of patients with severe respiratory failure related to COVID-19 require prolonged mechanical ventilation. Minimal data exists regarding the timing, safety, and efficacy of combined bedside percutaneous tracheostomy and endoscopy gastrostomy tube placement in these patients. The safety for healthcare providers is also in question. This study's objective was to evaluate the effectiveness and safety of combined bedside tracheostomy and gastrostomy tube placement in COVID-19 patients. Design and Methods: This is a single arm, prospective cohort study in patients with COVID-19 and acute respiratory failure requiring prolonged mechanical ventilation who underwent bedside tracheostomy and percutaneous endoscopic gastrostomy placement. Detailed clinical and procedural data were collected. Descriptive statistics were employed and time to event curves were estimated and plotted using the Kaplan Meier method for clinically relevant prespecified endpoints. Results: Among 58 patients, the median total intensive care unit (ICU) length of stay was 29 days (24.7-33.3) with a median of 10 days (6.3-13.7) postprocedure. Nearly 88% of patients were weaned from mechanical ventilation postprocedure at a median of 9 days (6-12); 94% of these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients were discharged alive from the hospital. All procedures were done at bedside with no patient transfer required out of the ICU. A median of 3.0 healthcare personnel total were present in the room per procedure. Conclusion: This study shows that survival of critically ill COVID-19 patients after tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are encouraging regarding time to weaning, downsizing, decannulation, and discharge. A combined procedure minimizes the risk of virus transmission to healthcare providers in addition to decreasing the number of anesthetic episodes, transfusions, and transfers patients must undergo. This approach should be considered in critically ill COVID-19 patients requiring prolonged mechanical ventilation.

ObjectiveTo examine whether the density of neighbourhood restaurants affected the frequency of eating restaurant meals and subsequently affected diet quality.DesignCross-sectional and longitudinal designs. Structural equation models assessed the indirect relationship between restaurant density (≤3 miles (4·8 km) of participant addresses) and dietary quality (Healthy Eating Index 2010 (HEI)) via the frequency of eating restaurant meals, after adjustment for sociodemographics, select health conditions, region, residence duration and area-level income.SettingUrbanised areas in multiple regions of the USA, years 2000-2002 and 2010-2012.ParticipantsParticipants aged 45-84 years were followed for 10 years (n 3567).ResultsMedian HEI (out of 100) was fifty-nine at baseline and sixty-two at follow-up. The cross-sectional analysis found that residing in areas with a high density of restaurants (highest-ranked quartile) was associated with 52 % higher odds of frequently eating restaurant meals (≥3 times/week, OR: 1·52, 95 % CI 1·18, 1·98) and 3 % higher odds of having lower dietary quality (HEI lowest quartile < 54, OR: 1·03, 95 % CI 1·01, 1·06); associations were not sustained in longitudinal analyses. The cross-sectional analysis found 34 % higher odds of having lower dietary quality for those who frequently ate at restaurants (OR: 1·34, 95 % CI 1·12, 1·61), and more restaurant meals (over time increase ≥ 1 time/week) were associated with higher odds of having worse dietary quality at follow-up (OR: 1·21, 95 % CI 1·00, 1·46).ConclusionsRestaurant density was associated with frequently eating out in cross-sectional and longitudinal analyses but was associated with the lower dietary quality only in cross-sectional analyses. Frequent restaurant meals were negatively related to dietary quality. Interventions that encourage less frequent eating out may improve population dietary quality.

Introduction: Low-income immigrants who are eligible to participate in the Supplemental Nutrition Assistance Program (SNAP) participate at lower rates compared to non-immigrants. Immigrant households may be more likely to participate in SNAP if they live in areas with policies that integrate them into society and protect them from deportation. Methods: Data on low-income immigrant households came from the 2019 American Community Survey (N = 87,678). The outcome was whether any household member received SNAP in the previous 12 months. Immigrant policy exposures came from two sources: the State Immigration Policy Resource, which includes 18 immigrant criminalizing and integrating policies, and a database that identified ‘sanctuary policies’ (SP), which we summarized at the county level. Multivariable logistic regression adjusted for person/household-level and area-level confounders. Results: Living in a jurisdiction with a SP was associated with 21% higher odds of enrolling in SNAP compared to living in a jurisdiction without a SP (adjusted odds ratio [aOR] 1.21, 95% CI=1.11,1.31). Relative to the least immigrant friendly states, living in the most immigrant-friendly states was associated with 16% higher odds of SNAP enrollment (aOR=1.16, 95%CI=1.06–1.28). When SP and state-level immigrant friendly policy environment were cross-classified, SNAP participation was 23% and 26% higher for those living in jurisdictions with one- and both- exposures, respectively, relative to those with neither (aOR 1.23; CI 1.12,1.36; aOR 1.26; CI 1.15,1.37). Conclusions: Many at high risk of food insecurity – including immigrants and citizens in households with immigrants – are eligible for SNAP but under-enroll. Policies that welcome and safeguard immigrants could reduce under enrollment.

Abstract Lung cancer is the leading cause of cancer‐related deaths worldwide. Surgery and chemoradiation are the standard of care in early stages of non‐small cell lung cancer (NSCLC), while immunotherapy is the standard of care in late‐stage NSCLC. The immune composition of the tumor microenvironment (TME) is recognized as an indicator for responsiveness to immunotherapy, although much remains unknown about its role in responsiveness to surgery or chemoradiation. In this pilot study, we characterized the NSCLC TME using mass cytometry (CyTOF) and bulk RNA sequencing (RNA‐Seq) with deconvolution of RNA‐Seq being performed by Kassandra, a recently published deconvolution tool. Stratification of patients based on the intratumoral abundance of B cells identified that the B‐cell rich patient group had increased expression of CXCL13 and greater abundance of PD1+ CD8 T cells. The presence of B cells and PD1+ CD8 T cells correlated positively with the presence of intratumoral tertiary lymphoid structures (TLS). We then assessed the predictive and prognostic utility of these cell types and TLS within publicly available stage 3 and 4 lung adenocarcinoma (LUAD) RNA‐Seq datasets. As previously described by others, pre‐treatment expression of intratumoral 12‐chemokine TLS gene signature is associated with progression free survival (PFS) in patients who receive treatment with immune checkpoint inhibitors (ICI). Notably and unexpectedly pre‐treatment percentages of intratumoral B cells are associated with PFS in patients who receive surgery, chemotherapy, or radiation. Further studies to confirm these findings would allow for more effective patient selection for both ICI and non‐ICI treatments.

Objective: This study examined the cross-sectional relationships between neighborhood social composition and gentrification, and acculturation stressors. Methods: Person-level data came from first-generation Chinese immigrants enrolled in the Immigrant Enclaves Study (Philadelphia, Pennsylvania, baseline 2018–2020, N = 512). A validated scale was used to assess 22 stressors associated with migration or acculturation. Neighborhood characteristics from the American Community Survey 2015–2019 and 2008–2012 included: tract proportion of foreign born Chinese, neighborhood wealth, and past decade gentrification. Most neighborhood exposures were modeled as continuous as well as binary variables (intended to represent highest level of neighborhood exposure). Multivariable negative binomial regression adjusted for age, gender, income, education, employment, language, years in the U.S., and neighborhood variables (proportion co-ethnic, and neighborhood per capita income). Results: The majority of participants spoke Mandarin (68% vs Cantonese 32%), mean participant age was 52.7 years old, years in the US was 18, and nearly one-half of the sample had less than 8 years of education. Mean number of stressors was 5.9 with nearly 20% of participants reporting 11 or more stressors. Multivariable results found the number of acculturation stressors was 18% lower for residents in the highest co-ethnic density neighborhoods and 13% lower for residents in the highest wealth areas, compared to other areas (expβ 0.82, 95% CI [CI] 0.69, 0.98; expβ 0.87, CI 0.75, 1.01, respectively). Stressors were no different whether participants lived in gentrified areas or not. Conclusions: Among middle-aged Chinese immigrants, acculturation stress was lower for residents in neighborhoods with higher proportion of Chinese immigrants and for residents in neighborhoods with higher wealth, whereas gentrification had no influence on acculturation stress. More work on this topic is needed with vulnerable populations such as this one, informed by local context.

Abstract Background There are hundreds of bikeshare programs worldwide, yet few health-related evaluations have been conducted. We enrolled a cohort of new bikeshare members in Philadelphia (Pennsylvania, USA) to assess whether within-person moderate and vigorous physical activity (MVPA) increased with higher use of the program and whether effects differed for vulnerable sub-groups. Methods During 2015–2018, 1031 new members completed baseline and one-year follow-up online surveys regarding their personal characteristics and past 7-day MVPA minutes per week (minutes per week with- and without walking). Participants were linked to their bikeshare trips to objectively assess program use. Negative binomial (for continuous outcomes) and multinomial (for categorical outcomes) regression adjusted for person characteristics (socio-demographics, health), weather, biking-infrastructure, and baseline biking. Results Participant median age was 30, 25% were of Black or Latino race/ethnicity, and 30% were socioeconomically disadvantaged. By follow-up, personal bike ownership increased and 75% used bikeshare, although most used it infrequently. Per 10 day change in past year (PY) bikeshare use, non-walking MVPA min/wk increased 3% (roughly 6 min/wk, P

Abstract Background Transport walking has drawn growing interest due to its potential to increase levels of physical activities and reduce reliance on vehicles. While existing studies have compared built environment-health associations between Euclidean buffers and network buffers, no studies have systematically quantified the extent of bias in health effect estimates when exposures are measured in different buffers. Further, prior studies have done the comparisons focusing on only one or two geographic regions, limiting generalizability and restricting ability to test whether direction or magnitude of bias are different by context. This study aimed to quantify the degree of bias in associations between built environment exposures and transport walking when exposures were operationalized using Euclidean buffers rather than network buffers in diverse contexts. Methods We performed a simulations study to systematically evaluate the degree of bias in associations between built environment exposures in Euclidean buffers and network buffers and transport walking, assuming network buffers more accurately captured true exposures. Additionally, we used empirical data from a multi-ethnic, multi-site cohort to compare associations between built environment amenities and walking for transport where built environment exposures were derived using Euclidean buffers versus network buffers. Results Simulation results found that the bias induced by using Euclidean buffer models was consistently negative across the six study sites (ranging from -80% to -20%), suggesting built environment exposures measured using Euclidean buffers underestimate health effects on transport walking. Percent bias was uniformly smaller for the larger 5 km scale than the 1 km and 0.25 km spatial scales, independent of site or built environment categories. Empirical findings aligned with the simulation results: built environment-health associations were stronger for built environment exposures operationalized using network buffers than using Euclidean buffers. Conclusion This study is the first to quantify the extent of bias in the magnitude of the associations between built environment exposures and transport walking when the former are measured in Euclidean buffers vs. network buffers, informing future research to carefully conceptualize appropriate distance-based buffer metrics in order to better approximate real geographic contexts. It also helps contextualize existing research in the field that used Euclidean buffers when that were the only option. Further, this study provides an example of the uncertain geographic context problem.

Abstract Background To examine whether changes in density of neighborhood alcohol outlets affected changes in alcohol consumption 1-year after regulatory changes increased alcohol availability. Methods Person-level data came from a population-based cohort (aged 21–64) residing in/around the Philadelphia, Pennsylvania metropolitan area (2016–2018, N = 772). Fifty-eight percent lived in a state that began implementing new regulations (Pennsylvania) and the remainder lived in states without major regulatory changes (Delaware and New Jersey). Alcohol consumption was assessed as days per week (pw), drinks pw, high consumption (≥8 drinks pw), and binge drinking. Availability of off-premise alcohol outlets was assessed using 1-mile density and distance. Regression models adjusted for age, gender, race/ethnicity, income, education, health status, state and population density. Results Cross-sectional analyses found that higher outlet density was associated with more alcohol consumption (days, drinks, high consumption; all p

Longitudinal associations between neighborhood characteristics and body mass index (BMI; weight (kg)/height (m)2) were assessed from 2000 to 2011 among 5,919 participants in the Multi-Ethnic Study of Atherosclerosis. The perceived availability of healthy food and walking environment were assessed via surveys, and 1-mile (1.6-km) densities of supermarkets, fruit-and-vegetable stores, and recreational facilities were obtained through a commercial database. Econometric fixed-effects models were used to estimate the association between within-person changes in neighborhood characteristics and within-person change in BMI. In fully adjusted models, a 1-standard-deviation increase in the healthy food environment index was associated with a 0.16-kg/m2 decrease in BMI (95% confidence interval (CI): -0.27, -0.06) among participants with obesity at baseline. A 1-standard-deviation increase in the physical activity environment index was associated with 0.13-kg/m2 (95% CI: -0.24, -0.02) and 0.14-kg/m2 (95% CI: -0.27, -0.01) decreases in BMI for participants who were overweight and obese at baseline, respectively. Paradoxically, increases in the physical activity index were associated with BMI increases in persons who were normal-weight at baseline. This study provides preliminary longitudinal evidence that favorable changes in neighborhood physical environments are related to BMI reductions in obese persons, who comprise a substantial proportion of the US population.

Background/Objective: Investigating trends in life expectancy and lifespan variation can highlight disproportionate mortality burdens among population subgroups. We examined inequalities in life expectancy and lifespan variation by race/ethnicity and by urbanicity in the US from 1990 to 2019. Methods: Using vital registration data for 322.0 million people in 3,141 counties from the National Center for Health Statistics, we obtained life expectancy at birth and lifespan variation for 16 race/ethnicity-gender-urbanicity combinations in six 5-year periods (1990–1994 to 2015–2019). Race/ethnicity was categorized as Hispanic, and non-Hispanic White, Black, and Asian/Pacific Islander. Urbanicity was categorized as metropolitan vs nonmetropolitan areas, or in six further detailed categorizations. Life expectancy and lifespan variation (coefficient of variation) were computed using life tables. Results: In 2015–2019, residents in metropolitan areas had higher life expectancies than their nonmetropolitan counterparts (79.6 years compared to 77.0 years). The widest inequality in life expectancy occurred between Asian/Pacific Islander women and Black men, with a 17.7-year gap for residents in metropolitan areas and a 16.9-year gap for residents in nonmetropolitan areas. Nonmetropolitan areas had greater dispersion around average age at death. Black individuals had the highest lifespan variations in both metropolitan and nonmetropolitan areas. Until the mid-2010s, life expectancy increased while lifespan variation decreased; however, recent trends show stagnation in life expectancy and increases in lifespan variation. Metropolitan-nonmetropolitan inequalities in both life expectancy and lifespan variation widened over time. Conclusion: Despite previous improvements in longevity, life expectancy is now stagnating while lifespan variation is increasing. Our results highlight that early-life deaths (i.e., young- and middle-age mortality) disproportionately affect Black individuals, who not only live the shortest lifespans but also have the most variability with respect to age at death.

Abstract Background Price promotions on sugar-sweetened beverages (SSBs) are commonly used by retailers to provide economic incentives for purchasing. Surprisingly, there is a lack of high-quality articles that examine the frequency and magnitude of sugary beverage discounting and consumer responses to discounts. The objective of this study is to quantify the association between exposure to price discounts and SSB purchases. Methods This cross-sectional study linked 2016 SSB consumption data from a U.S. household consumer panel (analytic sample N = 11,299 households) and weekly prices at stores where they shopped. We derived percent of the time SSBs were discounted (annual promotion frequency) and the amount of the discount (annual promotion magnitude) and assessed their association with household annual per capita SSB purchase ounces. Linear regression models adjusted for household size, income per capita, age, education, presence of children, race, occupation, region, and urbanicity. We also evaluated whether the association between promotion and purchase varied by socioeconomic status and race subgroups. Data were analyzed in 2019–2020. Results On average, households were exposed to SSBs price promotions 44% of the time. A 10-percentage point increase in annual SSB promotion frequency was associated with 13.7% increase in annual per capita purchasing (P 0.2). Conclusions More frequent and deeper price promotion was associated with higher annual per capita SSB purchases. Restricting SSB price promotions may be effective at reducing SSB consumption.

We investigated the relationships between neighborhood socio-demographic characteristics (socioeconomic status [SES], percentage of Black residents, and percentage of Hispanic residents) and survey-based measures of the social environment (social cohesion, safety) and the physical environment (healthy food environment, walking environment) in six sites from 2000 through 2011. Neighborhood environments were patterned by area SES and racial/ethnic composition, such that higher SES and lower percentage minority neighborhoods had better physical and social environments. Increasing disparities over time were observed for some neighborhood environments. Further research should explore the role of neighborhood environments in maintaining or increasing social disparities in health.

Plant water relations are critical for determining the distribution, persistence, and fitness of plant species. Studying the genetic basis of ecologically relevant traits, however, can be complicated by their complex genetic, physiological, and developmental basis and their interaction with the environment. Water use efficiency (WUE), the ratio of photosynthetic carbon assimilation to stomatal conductance to water, is a dynamic trait with tremendous ecological and agricultural importance whose genetic control is poorly understood. In the present study, we use a quantitative trait locus-mapping approach to locate, fine-map, clone, confirm, and characterize an allelic substitution that drives differences in WUE among natural accessions of Arabidopsis thaliana. We show that a single amino acid substitution in an abscisic acid-responsive kinase, AtMPK12, causes reduction in WUE, and we confirm its functional role using transgenics. We further demonstrate that natural alleles at AtMPK12 differ in their response to cellular and environmental cues, with the allele from the Cape Verde Islands (CVI) being less responsive to hormonal inhibition of stomatal opening and more responsive to short-term changes in vapor pressure deficit. We also show that the CVI allele results in constitutively larger stomata. Together, these differences cause higher stomatal conductance and lower WUE compared with the common allele. These physiological changes resulted in reduced whole-plant transpiration efficiency and reduced fitness under water-limited compared with well-watered conditions. Our work demonstrates how detailed analysis of naturally segregating functional variation can uncover the molecular and physiological basis of a key trait associated with plant performance in ecological and agricultural settings.

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in patients undergoing oncologic operations. We sought to identify risk factors for postoperative VTE to define high-risk groups that may benefit from enhanced prophylactic measures. A retrospective cohort analysis using The Society of Thoracic Surgeons General Thoracic Surgery Database was conducted on patients who underwent lung cancer resection between 2009 and 2021. Baseline characteristics and postoperative outcomes were compared between patients who did and did not develop a postoperative pulmonary embolism (PE) or deep venous thrombosis. Multivariable regression models identified risk factors associated with VTE. Of 57,531 patients who underwent lung cancer resection, a postoperative PE developed in 758 (1.3%). Patients with PE were more likely to be Black (12% vs 7%, P <.001), have interstitial fibrosis (3% vs 2%, P =.016), and prior VTE (12% vs 6%, P <.001). Postoperative PE was most likely to develop in patients with locally advanced disease who underwent bilobectomy (6% vs 4%, P <.001) or pneumonectomy (8% vs 5%, P <.001). Patients with postoperative PE had increased 30-day mortality (14% vs 3%, P <.001), reintubation (25% vs 8%, P <.001), and readmission (49% vs 15%, P <.001). On multivariable analysis, Black race (odds ratio, 1.74; 95% CI, 1.39-2.16; P <.001), interstitial fibrosis (odds ratio, 1.77; 95% CI, 1.15-2.72; P =.009), extent of resection, and increased operative duration were independently predictive of postoperative PE. A minimally invasive approach compared with thoracotomy was protective. Because nonmodifiable risk factors (Black race, interstitial fibrosis, and advanced-stage disease) predominate in postoperative PE and VTE-associated mortality is increased, enhanced perioperative prophylactic measures should be considered in high-risk cohorts. [Display omitted] [ABSTRACT FROM AUTHOR]

ObjectiveWhile behavioral change is necessary to reverse the obesity epidemic, it can be difficult to achieve and sustain in unsupportive residential environments. This study hypothesized that environmental resources supporting walking and a healthy diet are associated with reduced obesity incidence.Design and methodsData came from 4,008 adults aged 45-84 at baseline who participated in a neighborhood ancillary study of the Multi-Ethnic Study of Atherosclerosis. Participants were enrolled at six study sites at baseline (2000-2002) and neighborhood scales were derived from a supplementary survey that asked community residents to rate availability of healthy foods and walking environments for a 1-mile buffer area. Obesity was defined as BMI ≥ 30 kg/m(2) . Associations between incident obesity and neighborhood exposure were examined using proportional hazards and generalized linear regression.ResultsAmong 4,008 nonobese participants, 406 new obesity cases occurred during 5 years of follow-up. Neighborhood healthy food environment was associated with 10% lower obesity incidence per s.d. increase in neighborhood score. The association persisted after adjustment for baseline BMI and individual-level covariates (hazard ratio (HR) 0.88, 95% confidence interval (CI): 0.79, 0.97), and for correlated features of the walking environment but CIs widened to include the null (HR 0.89, 95% CI: 0.77, 1.03). Associations between neighborhood walking environment and lower obesity were weaker and did not persist after adjustment for correlated neighborhood healthy eating amenities (HR 0.98, 95% CI: 0.84, 1.15).ConclusionsAltering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a precondition for sustaining existing healthy behaviors and for adopting new healthy behaviors.

The role of adjuvant therapy in completely resected primary tumors that have components of both non–small cell lung cancer and small cell lung cancer (combined SCLC) is poorly understood. We sought to determine the potential benefits of adjuvant chemotherapy in patients who undergo complete resection for early-stage combined SCLC. Overall survival of patients with pathologic T1-2 N0 M0 combined SCLC who underwent complete resection in the National Cancer Database from 2004 to 2017, stratified by adjuvant chemotherapy vs surgery alone, was evaluated by multivariable Cox proportional hazards modeling and propensity score–matched analysis. Patients treated with induction therapy and those who died within 90 days of surgery were excluded from analysis. Of 630 patients who had pT1-2 N0 M0 combined SCLC during the study period, 297 patients (47%) underwent complete R0 resection. Adjuvant chemotherapy was administered to 63% of patients (n = 188), and 37% of patients underwent surgery alone (n = 109). In unadjusted analysis, the 5-year overall survival was 61.6% (95% CI, 50.8-70.7) for patients who underwent surgery alone and 66.4% (95% CI, 58.4-73.3) for patients who underwent adjuvant chemotherapy. In multivariable and propensity score–matched analysis, there were no significant differences in overall survival between adjuvant chemotherapy and surgery alone (adjusted hazard ratio, 1.16; 95% CI, 0.73-1.84). These findings were consistent when limited to patients who underwent lobectomies or to healthier patients who have at most 1 major comorbidity. In this national analysis, patients with pT1-2 N0 M0 combined SCLC treated with surgical resection alone have similar outcomes to those who undergo adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Few studies have evaluated physical activity changes in response to active transportation investments in low-income disadvantaged communities. This quasi-experimental pre-post paired location design assessed physical activity responses to a 1.5-mile urban greenway constructed in 2013 along arterial streets in a poor, high-crime, predominantly African-American neighborhood in Philadelphia, Pennsylvania. Pre-construction (2011) and post-construction (fall 2014), systematic observations (N = 8783) and environmental audit data were collected at the greenway and a comparison area. Post-construction intercept surveys were collected at the greenway (N = 175). Secondary data sources included census 2010–2014 and crime rates. Post-construction, there were notable improvements in street and sidewalk design, however, conditions remained sub-optimal and crime remained high. Most greenway users resided in the neighborhood and were daily users. Systematic observations at the greenway found slight increases in non-walking MVPA after construction (running or bicycling rose from 4% to 9%) and MVPA that included walking-fast (rose from 16% to 18%). However, the magnitude of the increase was similar to the increase in MVPA observed at the comparison site, which suggested that intensity of physical activity did not change as a result of the greenway (p-value > 0.15 for adjusted interaction between pre-post and location). Greenways, absent comprehensive improvements to the built and social environment, may be insufficient to promote MVPA in very disadvantaged high-crime urban communities. Keywords: Physical activity, Built environment, Neighborhood, Poverty, Active transportation, Walking, Walkability, Trail

The Course-Based Undergraduate Research Experiences Network (CUREnet) was initiated in 2012 with funding from the National Science Foundation program for Research Coordination Networks in Undergraduate Biology Education. CUREnet aims to address topics, problems, and opportunities inherent to integrating research experiences into undergraduate courses. During CUREnet meetings and discussions, it became apparent that there is need for a clear definition of what constitutes a CURE and systematic exploration of what makes CUREs meaningful in terms of student learning. Thus, we assembled a small working group of people with expertise in CURE instruction and assessment to: 1) draft an operational definition of a CURE, with the aim of defining what makes a laboratory course or project a "research experience"; 2) summarize research on CUREs, as well as findings from studies of undergraduate research internships that would be useful for thinking about how students are influenced by participating in CUREs; and 3) identify areas of greatest need with respect to CURE assessment, and directions for future research on and evaluation of CUREs. This report summarizes the outcomes and recommendations of this meeting.

Abstract There is growing interest among urban health researchers in addressing complex problems using conceptual and computation models from the field of complex systems. Agent-based modeling (ABM) is one computational modeling tool that has received a lot of interest. However, many researchers remain unfamiliar with developing and carrying out an ABM, hindering the understanding and application of it. This paper first presents a brief introductory guide to carrying out a simple agent-based model. Then, the method is illustrated by discussing a previously developed agent-based model, which explored inequalities in diet in the context of urban residential segregation.

Viruses are genetically diverse, infect a wide range of tissues and host cells and follow unique processes for replicating themselves. All these processes were investigated and indexed in ViralZone knowledge base. To facilitate standardizing data, a simple ontology of viral life-cycle terms was developed to provide a common vocabulary for annotating data sets. New terminology was developed to address unique viral replication cycle processes, and existing terminology was modified and adapted. The virus life-cycle is classically described by schematic pictures. Using this ontology, it can be represented by a combination of successive terms: "entry", "latency", "transcription", "replication" and "exit". Each of these parts is broken down into discrete steps. For example Zika virus "entry" is broken down in successive steps: "Attachment", "Apoptotic mimicry", "Viral endocytosis/ macropinocytosis", "Fusion with host endosomal membrane", "Viral factory". To demonstrate the utility of a standard ontology for virus biology, this work was completed by annotating virus data in the ViralZone, UniProtKB and Gene Ontology databases.

Objective: The movement to limit work hours for house staff has gained momentum in recent years. The authors set out to review the literature on work hours reform, particularly as it applies to psychiatric residency training, and to provide two different viewpoints on the controversy. Methods: The authors present the historical background of work hours reform in the United States and review recent literature about resident work hours limitations. Using a debate format, the authors discuss whether the new regulations are having a positive or negative impact on residency training in psychiatry. Results: Drs. Lomonaco and Auchincloss argue that currently-existing work hours restrictions may have unintended consequences for the health of patients and an untoward impact on residents' professional development and academic medicine's overall structure. Dr. Rasminsky argues that work hours restrictions do not go far enough in protecting residents and patients from the harmful effects of fatigue, and that our definition of professionalism needs to be reexamined in light of emerging scientific literature. Conclusion: There should be some limitation on resident work hours, with exact numbers to be determined by growing scientific knowledge about the effects of prolonged wakefulness. More study is needed, particularly in the area of psychiatric residency training.

Objective: To evaluate the safety and feasibility of implantation and retrieval of a novel implantable microdevice (IMD) in NSCLC patients undergoing operative resection. Background: Adjuvant therapy has limited impact on postsurgical outcomes in NSCLC due to the inability to predict optimal treatment regimens. Methods: An IMD measuring 6.5 mm by 0.7 mm, containing micro-reservoirs allowing for high-throughput localized drug delivery, was developed and loaded with 12 chemotherapeutic agents. Five patients with peripheral lung lesions larger than 1.0 cm were enrolled in this phase 1 clinical study. IMDs were inserted into tumors intraoperatively under direct vision, removed with the resected specimen, and retrieved in pathology. Surrounding tissues were sectioned, stained, and analyzed for tissue drug response to the IMD-delivered microdoses of these agents by a variety of pharmacodynamic markers. Results: A total of 14 IMDs were implanted intraoperatively with 13 (93%) successfully retrieved. After technique refinement, IMDs were reliably inserted and retrieved in open, Video-Assisted Thoracoscopic Surgery, and robotic cases. No severe adverse reactions were observed. The one retained IMD has remained in place without movement or any adverse effects. Analysis of patient blood revealed no detection of chemotherapeutic agents. We observed differential sensitivities of patient tumors to the drugs on the IMD. Conclusions: A multi-drug IMD can be safely inserted and retrieved into lung tumors during a variety of surgical approaches. Future studies will encompass preoperative placement to better examine specific tumor responsiveness to therapeutic agents, allowing clinicians to tailor treatment regimens to the microenvironment of each patient. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to better understand the triggers of suicide, particularly among the ‎ancient Greek and Persian soldiers and commanders.‎ Method: ‎‘Herodotus: The Histories’ is a history of the rulers and soldiery who participated in the ‎Greco-Persian wars (492-449 BCE). A new translation (2013) of this manuscript was studied. ‎Accounts of suicide were collected and collated, with descriptions of circumstances, ‎methods, and probable triggers.‎ Results: Nine accounts of suicide were identified. Eight of these were named individuals (4 Greeks ‎and 4 Persians); of whom, seven were male. Only one (not the female) appeared to act in ‎response to a mental disorder. Other triggers of suicide included guilt, avoidance of ‎dishonour/ punishment and altruism. Cutting/ stabbing was the most common method; others ‎included hanging, jumping, poison, and burning (the single female).‎ Conclusion: While soldiers at a time of war do not reflect the general community, they are nevertheless ‎members of their society. Thus, this evidence demonstrates that suicide triggered by ‎burdensome circumstances (in addition to mental disorder) was known to the Greek and ‎Persian people more than two millennia ago.‎

Quasi-experimental studies of menu labeling have found mixed results for improving diet. Differences between experimental groups can hinder interpretation. Propensity scores are an increasingly common method to improve covariate balance, but multiple methods exist and the improvements associated with each method have rarely been compared. In this re-analysis of the impact of menu labeling, we compare multiple propensity score methods to determine which methods optimize balance between experimental groups.Study participants included adult customers who visited full-service restaurants with menu labeling (treatment) and without (control). We compared the balance between treatment groups obtained by four propensity score methods: 1) 1:1 nearest neighbor matching (NN), 2) augmented 1:1 NN (using caliper of 0.2 and an exact match on an imbalanced covariate), 3) full matching, and 4) inverse probability weighting (IPW). We then evaluated the treatment effect on differences in nutrients purchased across the different methods.1:1 NN resulted in worse balance than the original unmatched sample (average standardized absolute mean distance [ASAM]: 0.185 compared to 0.171). Augmented 1:1 NN improved balance (ASAM: 0.038) but resulted in a large reduction in sample size. Full matching and IPW improved balance over the unmatched sample without a reduction in sample size (ASAM: 0.049 and 0.031, respectively). Menu labeling was associated with decreased calories, fat, sodium and carbohydrates in the unmatched analysis. Results were qualitatively similar in the propensity score matched/weighted models.While propensity scores offer an increasingly popular tool to improve causal inference, choosing the correct method can be challenging. Our results emphasize the benefit of examining multiple methods to ensure results are consistent, and considering approaches beyond the most popular method of 1:1 NN matching.

Recent studies suggest that obesity may be "contagious" between individuals in social networks. Social contagion (influence), however, may not be identifiable using traditional statistical approaches because they cannot distinguish contagion from homophily (the propensity for individuals to select friends who are similar to themselves) or from shared environmental influences. In this paper, we apply the stochastic actor-based model (SABM) framework developed by Snijders and colleagues to data on adolescent body mass index (BMI), screen time, and playing active sports. Our primary hypothesis was that social influences on adolescent body size and related behaviors are independent of friend selection. Employing the SABM, we simultaneously modeled network dynamics (friendship selection based on homophily and structural characteristics of the network) and social influence. We focused on the 2 largest schools in the National Longitudinal Study of Adolescent Health (Add Health) and held the school environment constant by examining the 2 school networks separately (N = 624 and 1151). Results show support in both schools for homophily on BMI, but also for social influence on BMI. There was no evidence of homophily on screen time in either school, while only one of the schools showed homophily on playing active sports. There was, however, evidence of social influence on screen time in one of the schools, and playing active sports in both schools. These results suggest that both homophily and social influence are important in understanding patterns of adolescent obesity. Intervention efforts should take into consideration peers' influence on one another, rather than treating "high risk" adolescents in isolation.

Mobility restrictions in older adults are common and increase the likelihood of negative health outcomes and premature mortality. The effect of built environment on mobility in older populations, among whom environmental effects may be strongest, is the focus of a growing body of the literature. We reviewed recent research (1990–2010) that examined associations of objective measures of the built environment with mobility and disability in adults aged 60 years or older. Seventeen empirical articles were identified. The existing literature suggests that mobility is associated with higher street connectivity leading to shorter pedestrian distances, street and traffic conditions such as safety measures, and proximity to destinations such as retail establishments, parks, and green spaces. Existing research is limited by differences in exposure and outcome assessments and use of cross-sectional study designs. This research could lead to policy interventions that allow older adults to live more healthy and active lives in their communities.