Geographic Accessibility and Completion of Initial Low-Dose CT-Based Lung Cancer Screening in an Urban Safety-Net Population.

BACKGROUND: Recent modifications to low-dose CT (LDCT)-based lung cancer screening guidelines increase the number of eligible individuals, particularly among racial and ethnic minorities. Because these populations disproportionately live in metropolitan areas, we analyzed the association between travel time and initial LDCT completion within an integrated, urban safety-net health care system. METHODS: Using Esri's StreetMap Premium, OpenStreetMap, and the r5r package in R, we determined projected private vehicle and public transportation travel times between patient residence and the screening facility for LDCT ordered in March 2017 through December 2022 at Parkland Memorial Hospital in Dallas, Texas. We characterized associations between travel time and LDCT completion in univariable and multivariable analyses. We tested these associations in a simulation of 10,000 permutations of private vehicle and public transportation distribution. RESULTS: A total of 2,287 patients were included in the analysis, of whom 1,553 (68%) completed the initial ordered LDCT. Mean age was 63 years, and 73% were underrepresented minorities. Median travel time from patient residence to the LDCT screening facility was 17 minutes by private vehicle and 67 minutes by public transportation. There was a small difference in travel time to the LDCT screening facility by public transportation for patients who completed LDCT versus those who did not (67 vs 66 min, respectively; P=.04) but no difference in travel time by private vehicle for these patients (17 min for both; P=.67). In multivariable analysis, LDCT completion was not associated with projected travel time to the LDCT facility by private vehicle (odds ratio, 1.01; 95% CI, 0.82-1.25) or public transportation (odds ratio, 1.14; 95% CI, 0.89-1.44). Similar results were noted across travel-type permutations. Black individuals were 29% less likely to complete LDCT screening compared with White individuals. CONCLUSIONS: In an urban population comprising predominantly underrepresented minorities, projected travel time is not associated with initial LDCT completion in an integrated health care system. Other reasons for differences in LDCT completion warrant investigation.

Accessibility to ERCP-performing hospitals among patients with pancreatic cancer living in SEER regions.

BACKGROUND AND AIMS: The two most common interventions used to treat painless jaundice from pancreatic cancer are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD). Our study aimed to characterize the geographic distribution of ERCP-performing hospitals among patients with pancreatic cancer in the United States and the association between geographic accessibility to ERCP-performing hospitals and biliary interventions patients receive. METHODS: This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database for pancreatic cancer from 2005 to 2013. Multilevel models were used to examine the association between accessibility to ERCP hospitals within a 30- and 45-min drive from the patient's residential ZIP Code and the receipt of ERCP treatment. A two-step floating catchment area model was used to calculate the measure of accessibility based on the distribution across SEER regions. RESULTS: 7464 and 782 patients underwent ERCP and PTBD, respectively, over the study period. There were 808 hospitals in which 8246 patients diagnosed with pancreatic cancer in SEER regions from 2005 to 2013 received a procedure. Patients with high accessibility within both 30- and 45-min drive to an ERCP-performing hospital were more likely to receive an ERCP (30-min adjusted odds ratio [aOR]: 1.53, 95% confidence interval [CI]: 1.17-2.01; 45-min aOR: 1.31, 95% CI: 1.01-1.70). Furthermore, in the adjusted model, Black patients (vs. White) and patients with stage IV disease were less likely to receive ERCP than PTBD. CONCLUSIONS: Patients with pancreatic cancer and high accessibility to an ERCP-performing hospital were more likely to receive ERCP. Disparities in the receipt of ERCP persisted for Black patients regardless of their access to ERCP-performing hospitals.

'Ease of adaptation' predicts preferred spectacle prescriptions better than visual acuity: a retrospective analysis.

CLINICAL RELEVANCE: Factors predicting patient acceptance of a new spectacle prescription need to be determined to make optimal prescribing decisions. BACKGROUND: Clinicians usually prescribe for best visual acuity. However, for some patients, a partial change is prescribed to ease adaptation, despite providing suboptimal visual acuity. This study seeks to develop an understanding of which factors predict patient preference between spectacle prescriptions by using a retrospective analysis to compare ease of adaptation, subjective quality of distance vision and optimal distance visual acuity. METHODS: A retrospective analysis utilised a 196-patient data set in which participants wore two prescriptions, one based on the subjective refraction of an optometrist modified by judgement and one on autorefractor results modified for ease of adaptation by an algorithm. Spectacles were worn for 3 weeks each, and participants responded to questions about which prescription they preferred and their quality of distance vision and ease of adaptation (on a 0-10 scale) with each prescription. A logistic regression analysed which variables predicted whether participants responded yes or no to the question 'If you had purchased these spectacles for $100 (US$200 adjusted to 2023 value), would you be happy with them?' RESULTS: There was a significant difference between the preferred and non-preferred prescriptions for the subjective quality of distance vision rating (medians 9 vs. 8; Z = -7.80, p < 0.0001) and ease of adaptation rating (medians 8 vs. 5; Z = -8.32, p < 0.0001) but the distance binocular visual acuity was not significantly different (both means = -0.09 logMAR; Z = -0.60, p = 0.55). Of all participants, 94% preferred the prescription deemed easier to adapt to but only 59% preferred the prescription with better subjective quality of distance vision and best visual acuity. CONCLUSION: Distance visual acuity was not found to be a useful predictor of participant preference to a new prescription and is likely over-relied upon in practice. The results support the adjustment of the subjective prescription where appropriate to aid patient adaptation and comfort.

Data gaps and opportunities for modeling cancer health equity.

Population models of cancer reflect the overall US population by drawing on numerous existing data resources for parameter inputs and calibration targets. Models require data inputs that are appropriately representative, collected in a harmonized manner, have minimal missing or inaccurate values, and reflect adequate sample sizes. Data resource priorities for population modeling to support cancer health equity include increasing the availability of data that 1) arise from uninsured and underinsured individuals and those traditionally not included in health-care delivery studies, 2) reflect relevant exposures for groups historically and intentionally excluded across the full cancer control continuum, 3) disaggregate categories (race, ethnicity, socioeconomic status, gender, sexual orientation, etc.) and their intersections that conceal important variation in health outcomes, 4) identify specific populations of interest in clinical databases whose health outcomes have been understudied, 5) enhance health records through expanded data elements and linkage with other data types (eg, patient surveys, provider and/or facility level information, neighborhood data), 6) decrease missing and misclassified data from historically underrecognized populations, and 7) capture potential measures or effects of systemic racism and corresponding intervenable targets for change.

Characteristics of self-triaged emergency department visits by adults with cancer.

OBJECTIVES: Adults with a new diagnosis of cancer frequently visit emergency departments (EDs) for disease- and treatment-related issues, although not exclusively. Many cancer care providers have 24/7 clinician phone triage available, but initial recorded phone messages tend to advise patients to go to the nearest ED if they are "experiencing a medical emergency." It is unclear how well patients triage themselves to the optimal site of care. STUDY DESIGN: Cross-sectional study of tumor registry records (university patients diagnosed 2008-2018 and safety-net patients diagnosed 2012-2018) identifiably linked to electronic health records and a regional health information exchange. METHODS: We geoprocessed addresses to calculate driving time distance from the patient's home to the ED. We used mixed-effects regression to predict the diagnosis code-based severity for ED visits within 6 months of diagnosis, clustering visits within patients and hospitals. RESULTS: A total of 39,498 adults made 38,944 ED visits to 67 different hospitals. Patients self-referred for 85.5% of visits and bypassed a median (IQR) of 13 (4-33) closer EDs. Visits closer to home were not significantly more clinically severe; visits were significantly less severe if the patient self-referred (adjusted odds ratio [AOR], 0.89; 95% CI, 0.81-0.97) or they were on weekends (AOR, 0.93; 95% CI, 0.87-0.99). Reanalyzing within each individual health system also showed similar findings. CONCLUSIONS: Adults with cancer infrequently use available clinician advice before visiting the ED and may use factors other than clinical severity to determine their need for emergency care. Future work should explore the challenges that patients face navigating unplanned acute care, including reasons for underusing existing resources.

Immune modulation in chronic myeloid leukaemia patients treated with nilotinib and interferon-alpha.

The addition of interferon to tyrosine kinase inhibitors (TKIs), to improve deep molecular response (DMR) and potentially treatment-free remission (TFR) rates in chronic-phase chronic myeloid leukaemia (CP-CML) patients is under active investigation. However, the immunobiology of this combination is poorly understood. We performed a comprehensive longitudinal assessment of immunological changes in CML patients treated with nilotinib and interferon-alpha (IFN-α) within the ALLG CML11 trial (n = 12) or nilotinib alone (n = 17). We demonstrate that nilotinib+IFN transiently reduced absolute counts of natural killer (NK) cells, compared with nilotinib alone. Furthermore, CD16+ -cytolytic and CD57+ CD62L- -mature NK cells were transiently reduced during IFN therapy, without affecting NK-cell function. IFN transiently increased cytotoxic T-lymphocyte (CTL) responses to leukaemia-associated antigens (LAAs) proteinase-3, BMI-1 and PRAME; and had no effect on regulatory T cells, or myeloid-derived suppressor cells. Patients on nilotinib+IFN who achieved MR4.5 by 12 months had a significantly higher proportion of NK cells expressing NKp46, NKp30 and NKG2D compared with patients not achieving this milestone. This difference was not observed in the nilotinib-alone group. The addition of IFN to nilotinib drives an increase in NK-activating receptors, CTLs responding to LAAs and results in transient immune modulation, which may influence earlier DMR, and its effect on long-term outcomes warrants further investigation.

Asian American Enclaves and Healthcare Accessibility: An Ecologic Study Across Five States.

INTRODUCTION: Access to primary care has been a long-standing priority for improving population health. Asian Americans, who often settle in ethnic enclaves, have been found to underutilize health care. Understanding geographic primary care accessibility within Asian American enclaves can help to ensure the long-term health of this fast-growing population. METHODS: U.S. Census data from five states (California, Florida, New Jersey, New York, and Texas) were used to develop and describe census-tract level measures of Asian American enclaves and social and built environment characteristics for years 2000 and 2010. The 2-step floating catchment area method was applied to National Provider Identifier data to develop a tract-level measure of geographic primary care accessibility. Analyses were conducted in 2022-2023, and associations between enclaves (versus nonenclaves) and geographic primary care accessibility were evaluated using multivariable Poisson regression with robust variance estimation, adjusting for potential area-level confounders. RESULTS: Of 24,482 census tracts, 26.1% were classified as Asian American enclaves. Asian American enclaves were more likely to be metropolitan and have less poverty, lower crime, and lower proportions of uninsured individuals than nonenclaves. Asian American enclaves had higher primary care accessibility than nonenclaves (adjusted prevalence ratio=1.23, 95% CI=1.17, 1.29). CONCLUSIONS: Asian American enclaves in five of the most diverse and populous states in the U.S. had fewer markers of disadvantage and greater geographic primary care accessibility. This study contributes to the growing body of research elucidating the constellation of social and built environment features within Asian American enclaves and provides evidence of health-promoting characteristics of these neighborhoods.

Effective inclusion practices for neurodiverse children and adolescents in informal STEM learning: a systematic review protocol.

BACKGROUND: Informal learning experiences in science, technology, engineering, and math (STEM) can enhance STEM learning that occurs in formal educational settings and curricula as well as generate enthusiasm for considering STEM careers. The aim of this systematic review is to focus on the experiences of neurodiverse students in informal STEM learning. Neurodiversity is a subgroup of neurodevelopmental conditions, such as autism, attention deficit disorder, dyslexia, dyspraxia, and other neurological conditions. The neurodiversity movement regards these conditions as natural forms of human variation, as opposed to dysfunction, and recognizes that neurodiverse individuals possess many strengths relevant to STEM fields. METHODS: The authors will systematically search electronic databases for relevant research and evaluation articles addressing informal STEM learning for K-12 children and youth with neurodiverse conditions. Seven databases and content-relevant websites (e.g., informalscience.org) will be searched using a predetermined search strategy and retrieved articles will be screened by two members of the research team. Data synthesis will include meta-synthesis techniques, depending on the designs of the studies. DISCUSSION: The synthesis of the findings resulting from various research and evaluation designs, across the K-12 age span, and across various informal STEM learning contexts, will lead to depth and breadth of understanding of ways to improve informal STEM learning programs for neurodiverse children and youth. The identification of informal STEM learning program components and contexts shown to yield positive results will provide specific recommendations for improving inclusiveness, accessibility, and STEM learning for neurodiverse children and youth. TRIAL REGISTRATION: The current study has been registered in PROSPERO. REGISTRATION NUMBER: CRD42021278618.

Distance spectacle-wearing habits in older patients in England.

PURPOSE: To report the proportion of older people in England who wear distance spectacles full time, part time and rarely, and to investigate factors that influence how much the distance vision (DV) correction is worn. METHODS: A two-part questionnaire investigating the spectacle-wearing habits of older people was developed and completed by 322 participants (age 72 years ±7.7, range 60-94). A subcohort of 209 DV correction wearers with a mean spherical equivalent (MSE) of <±4.00DS was selected for a logistic regression to investigate which factors influence how much the DV correction is used. RESULTS: In total, 43% of emmetropic, and 55% of pseudophakic, DV spectacle wearers wear their correction full time. Lens type, MSE and the age that participants first wore a DV correction significantly predicted DV correction wearing habit (adjusted R2 = 0.36), with lens type being the strongest predicting factor and progressive users wearing their spectacles 37% more than those using single vision lenses. CONCLUSIONS: Many patients appear to consider convenience more important than being spectacle independent at distance, with lens type the most significant influencing factor of how much those with low/moderate refractive error wear their distance correction. Many emmetropes and pseudophakes choose to wear their progressive or bifocal spectacles full time, and the emmetropia provided by cataract surgery does not provide independence from full-time spectacle wear for many patients. The optometrist has a key role in discussing both choice of spectacle lens correction and the refractive outcome options of cataract surgery with patients.

How Is Functional Neurological Disorder Managed in Australian Hospitals? A Multi-Site Study Conducted on Acute Inpatient and Inpatient Rehabilitation Wards.

Background: Successful management for functional neurological disorder (FND) requires multidisciplinary involvement starting with providing a definitive diagnosis. Objectives: To observe clinical management of patients with FND during hospital admission. Methods: A prospective observational study was conducted over six Australian hospitals over a 4-month period. Data collected included patient demographics, communication of the diagnosis of FND, access to the multidisciplinary team, hospital length of stay (LOS), and emergency department (ED) presentations. Results: A total of 113 patients were included. Median LOS was 6 (interquartile range, 3-14) days. Thirty-five (31%) presented to ED with 9 (8%) re-presenting two or more times after hospital discharge. Total hospital utilization cost was AUD$3.5million. A new diagnosis was made in 82 (73%) patients. Inpatient referrals were made to neurology (81, 72%), psychology (29, 26%), psychiatry (27, 24%), and physiotherapy (100, 88%). Forty-four (54%) were not told of the diagnosis. Twenty (24%) did not have their diagnosis documented in their medical record. Of the 19 (23%) not reviewed by neurology on non-neurosciences wards, 17 (89%) did not have their diagnosis communicated and 11 (58%) did not have it documented. Twenty-five (42%) referred to neurology were not provided with a diagnosis. Conclusions: Current gaps in service provision during inpatient hospital admissions in Australia include low rates of communication of a diagnosis, particularly when patients are not located on a neurosciences ward, and limited and variable access to inpatient multidisciplinary teams. Specialized services are needed to improve education, clinical pathways, communication, and health outcomes while reducing healthcare system costs.

Correction: The Association of a Geographically Wide Social Media Network on Depression: County-Level Ecological Analysis.

[This corrects the article DOI: 10.2196/43623.].

The Association of a Geographically Wide Social Media Network on Depression: County-Level Ecological Analysis.

BACKGROUND: Social connectedness decreases human mortality, improves cancer survival, cardiovascular health, and body mass, results in better-controlled glucose levels, and strengthens mental health. However, few public health studies have leveraged large social media data sets to classify user network structure and geographic reach rather than the sole use of social media platforms. OBJECTIVE: The objective of this study was to determine the association between population-level digital social connectedness and reach and depression in the population across geographies of the United States. METHODS: Our study used an ecological assessment of aggregated, cross-sectional population measures of social connectedness, and self-reported depression across all counties in the United States. This study included all 3142 counties in the contiguous United States. We used measures obtained between 2018 and 2020 for adult residents in the study area. The study's main exposure of interest is the Social Connectedness Index (SCI), a pair-wise composite index describing the "strength of connectedness between 2 geographic areas as represented by Facebook friendship ties." This measure describes the density and geographical reach of average county residents' social network using Facebook friendships and can differentiate between local and long-distance Facebook connections. The study's outcome of interest is self-reported depressive disorder as published by the Centers for Disease Control and Prevention. RESULTS: On average, 21% (21/100) of all adult residents in the United States reported a depressive disorder. Depression frequency was the lowest for counties in the Northeast (18.6%) and was highest for southern counties (22.4%). Social networks in northeastern counties involved moderately local connections (SCI 5-10 the 20th percentile for n=70, 36% of counties), whereas social networks in Midwest, southern, and western counties contained mostly local connections (SCI 1-2 the 20th percentile for n=598, 56.7%, n=401, 28.2%, and n=159, 38.4%, respectively). As the quantity and distance that social connections span (ie, SCI) increased, the prevalence of depressive disorders decreased by 0.3% (SE 0.1%) per rank. CONCLUSIONS: Social connectedness and depression showed, after adjusting for confounding factors such as income, education, cohabitation, natural resources, employment categories, accessibility, and urbanicity, that a greater social connectedness score is associated with a decreased prevalence of depression.

A CpG island-encoded mechanism protects genes from premature transcription termination.

Transcription must be tightly controlled to regulate gene expression and development. However, our understanding of the molecular mechanisms that influence transcription and how these are coordinated in cells to ensure normal gene expression remains rudimentary. Here, by dissecting the function of the SET1 chromatin-modifying complexes that bind to CpG island-associated gene promoters, we discover that they play a specific and essential role in enabling the expression of low to moderately transcribed genes. Counterintuitively, this effect can occur independently of SET1 complex histone-modifying activity and instead relies on an interaction with the RNA Polymerase II-binding protein WDR82. Unexpectedly, we discover that SET1 complexes enable gene expression by antagonising premature transcription termination by the ZC3H4/WDR82 complex at CpG island-associated genes. In contrast, at extragenic sites of transcription, which typically lack CpG islands and SET1 complex occupancy, we show that the activity of ZC3H4/WDR82 is unopposed. Therefore, we reveal a gene regulatory mechanism whereby CpG islands are bound by a protein complex that specifically protects genic transcripts from premature termination, effectively distinguishing genic from extragenic transcription and enabling normal gene expression.

Impact of a dietitian in general practice: paediatric food allergy.

BACKGROUND: Food allergy in infants and young children places a significant burden on primary care. This study evaluated a dietetic-led paediatric food allergy service, which attempts to provide more rapid access to the dietitian and reduce the need for general practitioner (GP) and secondary care appointments. METHODS: Two community dietetic services for children referred with food allergy were compared. The first was dietetic-led care where dietitians train community children's nurses to recognise potential cases of food allergy, undertake basic diagnostic assessment and subsequently refer to the dietitian. The other was a more traditional dietetic community service where patients were referred predominantly by the GP or secondary care. RESULTS: In dietetic-led care 86 patients were seen, compared to 96 in dietetic community care. Dietetic-led care received fewer referrals from the GP, 36% versus 67% (p < 0.001); GP appointments for allergy-related conditions prior to dietetic referral were lower, 3 versus 6 visits (p = 0.001); and input from secondary care was also lower, 8 versus 25 patients (p = 0.002) compared with dietetic community care. Children referred to dietetic-led care were younger, 78% <6 months versus 40% (p < 0.001) in dietetic community care. CONCLUSIONS: Dietetic-led care describes a model that has the potential to reduce GP and secondary care appointments, identify patients more quickly and reduce the time to receive dietetic input, thereby resolving symptoms more quickly and reducing prescribed medications. This model demonstrates the importance of integrated care and multidisciplinary working, offering a solution to reducing GP workload while maintaining or improving patient care.

Drooling and Aspiration of Saliva.

Drooling and aspiration of saliva can affect the quality of life and morbidity of patients with neuromuscular diseases. Practitioners must differentiate between drooling with and without aspiration of saliva, as the presence of aspiration affects respiratory health. There are several validated drooling scales, but validated assessments for aspiration of saliva are lacking. Once diagnosed, drooling can be treated with rehabilitative therapy, anticholinergics, botulinum toxin to the salivary glands, and surgery. Drooling with aspiration of saliva often requires multidisciplinary engagement to decrease the risk of respiratory complications.

The Texas Health Resources Clinical Scholars Program: Learning healthcare system workforce development through embedded translational research.

Introduction: Texas Health Resources (THR), a large, nonprofit health care system based in the Dallas-Fort Worth area, has collaborated with the University of Texas Southwestern Medical Center (UTSW) to develop and operate a unique, integrated approach for Learning Health System (LHS) workforce development. This training model centers on academic health system faculty members conducting later-stage translational research within a partnering regional care delivery organization. Methods: The THR Clinical Scholars Program engages early career UTSW faculty members to conduct studies that are likely to have an impact on care delivery at the health system level. Interested candidates submit formal applications to the program. A joint committee comprised of senior research faculty from UTSW and THR clinical leadership reviews proposals with a focus on the shared LHS needs of both institutions-developing high quality research output that can be applied to enhance care delivery. A key prioritization criterion for funding is the degree to which the research addresses a question relevant to THR as a high-volume network with multiple channels for consumers to access care. The program emphasis is on supporting embedded research initiatives using health system data to generate knowledge that will improve the quality and efficiency of care for the patient populations served by the participant organizations. Results: We discuss specific strategic and tactical components of the THR Clinical Scholars Program including an overview of the academic affiliation agreement between the collaborating organizations, criteria for successful program applications, data sharing, and funding. We also share project summaries from selected clinical scholars as examples of the LHS research done in the program to date. Conclusion: This experience report provides an implementation framework for other academic health systems interested in adopting similar LHS workforce training models with community partners.

Real-Time Patient Portal Use Among Emergency Department Patients: An Open Results Study.

OBJECTIVES: We characterized real-time patient portal test result viewing among emergency department (ED) patients and described patient characteristics overall and among those not enrolled in the portal at ED arrival. METHODS: Our observational study at an academic ED used portal log data to trend the proportion of adult patients who viewed results during their visit from May 04, 2021 to April 04, 2022. Correlation was assessed visually and with Kendall's τ. Covariate analysis using binary logistic regression assessed result(s) viewed as a function of time accounting for age, sex, ethnicity, race, language, insurance status, disposition, and social vulnerability index (SVI). A second model only included patients not enrolled in the portal at arrival. We used random forest imputation to account for missingness and Huber-White heteroskedasticity-robust standard errors for patients with multiple encounters (α = 0.05). RESULTS: There were 60,314 ED encounters (31,164 unique patients). In 7,377 (12.2%) encounters, patients viewed results while still in the ED. Patients were not enrolled for portal use at arrival in 21,158 (35.2%) encounters, and 927 (4.4% of not enrolled, 1.5% overall) subsequently enrolled and viewed results in the ED. Visual inspection suggests an increasing proportion of patients who viewed results from roughly 5 to 15% over the study (Kendall's τ = 0.61 [p <0.0001]). Overall and not-enrolled models yielded concordance indices (C) of 0.68 and 0.72, respectively, with significant overall likelihood ratio χ 2 (p <0.0001). Time was independently associated with viewing results in both models after adjustment. Models revealed disparate use between age, race, ethnicity, SVI, sex, insurance status, and disposition groups. CONCLUSION: We observed increased portal-based test result viewing among ED patients over the year since the 21st Century Cures act went into effect, even among those not enrolled at arrival. We observed disparities in those who viewed results.

Colorectal Cancer Incidence, Inequalities, and Prevention Priorities in Urban Texas: Surveillance Study With the "surveil" Software Package.

BACKGROUND: Monitoring disease incidence rates over time with population surveillance data is fundamental to public health research and practice. Bayesian disease monitoring methods provide advantages over conventional methods including greater flexibility in model specification and the ability to conduct formal inference on model-derived quantities of interest. However, software platforms for Bayesian inference are often inaccessible to nonspecialists. OBJECTIVE: To increase the accessibility of Bayesian methods among health surveillance researchers, we introduce a Bayesian methodology and open source software package, surveil, for time-series modeling of disease incidence and mortality. Given case count and population-at-risk data, the software enables health researchers to draw inferences about underlying risk and derivative quantities including age-standardized rates, annual and cumulative percent change, and measures of inequality. METHODS: We specify a Poisson likelihood for case counts and model trends in log-risk using the first-difference (random-walk) prior. Models in the surveil R package were built using the Stan modeling language. We demonstrate the methodology and software by analyzing age-standardized colorectal cancer (CRC) incidence rates by race and ethnicity for non-Latino Black (Black), non-Latino White (White), and Hispanic/Latino (of any race) adults aged 50-79 years in Texas's 4 largest metropolitan statistical areas between 1999 and 2018. RESULTS: Our analysis revealed a cumulative decline of 31% (95% CI -37% to -25%) in CRC risk among Black adults, 17% (95% CI -23% to -11%) for Latino adults, and 35% (95% CI -38% to -31%) for White adults from 1999 to 2018. None of the 3 observed groups experienced significant incidence reduction in the final 4 years of the study (2015-2018). The Black-White rate difference (per 100,000) was 44 (95% CI 30-57) in 1999 and 35 (95% CI 28-43) in 2018. Cumulatively, the Black-White gap accounts for 3983 CRC cases (95% CI 3746-4219) or 31% (95% CI 29%-32%) of total CRC incidence among Black adults in this period. CONCLUSIONS: Stalled progress on CRC prevention and excess CRC risk among Black residents warrant special attention as cancer prevention and control priorities in urban Texas. Our methodology and software can help the public and health agencies monitor health inequalities and evaluate progress toward disease prevention goals. Advantages of the methodology over current common practice include the following: (1) the absence of piecewise linearity constraints on the model space, and (2) formal inference can be undertaken on any model-derived quantities of interest using Bayesian methods.

Burn mass casualty incidents in Europe: A European response plan within the European Union Civil Protection Mechanism.

BACKGROUND: Burn care is centralized in highly specialized burn centers in Europe. These centers are of limited capacity and may be overwhelmed by a sudden surge in case of a burn mass casualty incident. Prior incidents in Europe and abroad have sustained high standards of care through well-orchestrated responses to share the burden of care in several burn centers. A burn mass casualty incident in Romania in 2015 sparked an initiative to strengthen the existing EU mechanisms. This paper aims to provide insight into developing a response plan for burn mass casualties within the EU Civil Protection Mechanism. METHODS: The European Burns Association drafted medical guidelines for burn mass casualty incidents based on a literature review and an in-depth analysis of the Romanian incident. An online questionnaire surveyed European burn centers and EU States for burn mass casualty preparedness. RESULTS: The Romanian burn mass casualty in 2015 highlighted the lack of a burn-specific mechanism, leading to the late onset of international transfers. In Europe, 71% of respondents had existing mass casualty response plans, though only 35% reported having a burn-specific plan. A burns response plan for burn mass casualties was developed and adopted as a Commission staff working document in preparation for further implementation. The plan builds on the existing Union Civil Protection Mechanism framework and the standards of the WHO Emergency Medical Teams initiative to provide 1) burn assessment teams for specialized in-hospital triage of patients, 2) specialized burn care across European burn centers, and 3) medevac capacities from participating states. CONCLUSION: The European burn mass casualty response plan could enable the delivery of high-level burn care in the face of an overwhelming incident in an affected European country. Further steps for integration and implementation of the plan within the Union Civil Protection Mechanism framework are needed.

Real-world evaluation of osteoporotic fractures using the Japan Medical Data Vision database.

In Japanese patients who experienced an osteoporotic fracture, 10.8% and 18.6% had a subsequent fracture within 1 and 2 years of follow-up, respectively. Although the burden of hip and vertebral fractures has been reported widely, we found that patients with non-hip non-vertebral (NHNV) fractures had a 26% higher risk of subsequent fracture than patients with hip fractures; therefore, NHNV fractures should also be considered an important risk factor for subsequent fracture. INTRODUCTION: To investigate imminent risk and odds of subsequent osteoporotic fractures and associated risk factors in patients who experienced an initial osteoporotic fracture. METHODS: Patients aged ≥ 50 years with ≥ 1 osteoporotic fracture were analyzed from Japan's Medical Data Vision (MDV) database of claims from acute-care hospitals (January 2012-January 2017). Multivariable models were constructed to explore the impact of key comorbidities and medications on the subsequent fracture risk: Cox proportional hazards model for time to subsequent fracture and logistic regression models for odds of subsequent fracture within 1 and 2 years from index fracture. RESULTS: In total, 32,926 patients were eligible with a median follow-up duration of 12.3 months. The percentage of patients experiencing subsequent fractures was 14.1% across the study duration, and 10.8% and 18.6% in patients with 1 and 2 years of follow-up, respectively. In the Cox proportional hazards model, patients with vertebral or NHNV index fractures had a higher subsequent fracture risk than patients with a hip index fracture (adjusted hazard ratio [aHR] 1.11 and 1.26, respectively); subsequent fracture risk was lower in males than females (aHR 0.89). Patients with baseline claims for tranquilizers and glucocorticoids had a higher subsequent fracture risk than those without (aHR 1.14 and 1.08, respectively). Additionally, baseline claims for anti-Parkinson's medications, alcoholism, and stage 4/5 chronic kidney disease were significantly associated with higher odds of subsequent fracture in the logistic regression models. CONCLUSION: Several clinical and demographic factors were associated with a higher risk and odds of subsequent fracture. This may help to identify patients who should be prioritized for osteoporosis treatment.