Decomposition of disparities in life expectancy with applications to administrative health claims and registry data.

Research shows that geographic disparities in life expectancy between leading and lagging states are increasing over time while racial disparities between Black and White Americans have been going down. In the 65+ age strata morbidity is the most common cause of death, making differences in morbidity and associated adverse health-related outcomes between advantaged and disadvantaged groups an important aspect of disparities in life expectancy at age 65 (LE65). In this study, we used Pollard's decomposition to evaluate the disease-related contributions to disparities in LE65 for two types of data with distinctly differing structures: population/registry and administrative claims. To do so, we analyzed Pollard's integral, which is exact by construction, and developed exact analytic solutions for both types of data without the need for numerical integration. The solutions are broadly applicable and easily implemented. Applying these solutions, we found that the largest relative contributions to geographic disparities in LE65 were chronic lower respiratory diseases, circulatory diseases, and lung cancer; and, to racial disparities: arterial hypertension, diabetes mellitus, and cerebrovascular diseases. Overall, the increase in LE65 observed over 1998-2005 and 2010-2017 was primarily due to a reduction in the contributions of acute and chronic ischemic diseases; this was partially offset by increased contributions of diseases of the nervous system including dementia and Alzheimer's disease.

Forecasting prevalence and mortality of Alzheimer's disease using the partitioning models.

OBJECTIVES: Health forecasting is an important aspect of ensuring that the health system can effectively respond to the changing epidemiological environment. Common models for forecasting Alzheimer's disease and related dementias (AD/ADRD) are based on simplifying methodological assumptions, applied to limited population subgroups, or do not allow analysis of medical interventions. This study uses 5 %-Medicare data (1991-2017) to identify, partition, and forecast age-adjusted prevalence and incidence-based mortality of AD as well as their causal components. METHODS: The core underlying methodology is the partitioning analysis that calculates the relative impact each component has on the overall trend as well as intertemporal changes in the strength and direction of these impacts. B-spline functions estimated for all parameters of partitioning models represent the basis for projections of these parameters in future. RESULTS: Prevalence of AD is predicted to be stable between 2017 and 2028 primarily due to a decline in the prevalence of pre-AD-diagnosis stroke. Mortality, on the other hand, is predicted to increase. In all cases the resulting patterns come from a trade-off of two disadvantageous processes: increased incidence and disimproved survival. Analysis of health interventions demonstrates that the projected burden of AD differs significantly and leads to alternative policy implications. DISCUSSION: We developed a forecasting model of AD/ADRD risks that involves rigorous mathematical models and incorporation of the dynamics of important determinative risk factors for AD/ADRD risk. The applications of such models for analyses of interventions would allow for predicting future burden of AD/ADRD conditional on a specific treatment regime.

Underlying mechanisms of change in cancer prevalence in older U.S. adults: contributions of incidence, survival, and ascertainment at early stages.

PURPOSE: To quantitatively evaluate contributions of trends in incidence, relative survival, and stage at diagnosis to the dynamics in the prevalence of major cancers (lung, prostate, colon, breast, urinary bladder, ovaries, stomach, pancreas, esophagus, kidney, liver, and skin melanoma) among older U.S. adults age 65 +. METHODS: Trend partitioning was applied to the Surveillance, Epidemiology, and End Results Program data for 1973-2016. RESULTS: Growth of cancer prevalence in older adults decelerated or even decreased over time for all studied cancers due to decreasing incidence and improving survival for most of cancers, with a smaller contribution of the stage at cancer diagnosis. Changes in the prevalence of cancers of the lung, colon, stomach, and breast were predominantly due to decreasing incidence, increasing survival and more frequent diagnoses at earlier stages. Changes in prevalence of some other cancers demonstrated adverse trends such as decreasing survival in localized and regional stages (urinary bladder and ovarian) and growing impact of late-stage diagnoses (esophageal cancer). CONCLUSION: While decelerating or decreasing prevalence of many cancers were due to a beneficial combination of decreasing incidence and increasing survival, there are cancers for which decelerating prevalence is due to lack of improvement in their stage-specific survival and/or increasing frequency of diagnosis at advanced stages. Overall, if the observed trends persist, it is likely that the burden associated with cancer prevalence in older U.S. adults will be lower  comparing to projections based on constant increasing prevalence have previously estimated.

[Early Stages of Skull Embryogenesis in the Grass Snake, Natrix natrix (Serpentes, Colubridae)].

Studies of previous authors on snake skull embryogenesis have been performed on embryos obtained from eggs after oviposition. The aim of this study was to investigate the initial stages of chondrocranium development in Grass-snake Natrixnatrix Linnaeus, 1758, embryos before oviposition. Natrix natrix embryos at early developmental stages (24-27 according to the table of normal development by D. Zehr (1962)) were obtained by means of caesarean section. At developmental stages 25-27, previously undescribed structures were found in the region of future skull formation. These structures exist during one or two stages and then disappear. Therefore, we call them "temporary structures." The assumption about the nature of these structures is based on their topography and comparison with the structures of developing or fully formed chondrocranium in other vertebrates. It is hypothesized that the temporary structures in Natrix natrix chondrocranium are vestiges ofprimary chondrocranium of ancestral vertebrate forms, and they indicate the existence of several variants in the formation of chondrocranium in the historical vertebrates.' development.

Resuspension and redistribution of radionuclides during grassland and forest fires in the Chernobyl exclusion zone: part I. Fire experiments.

Controlled burning of experimental plots of forest or grassland in the Chernobyl exclusion zone has been carried out in order to estimate the parameters of radionuclide resuspension, transport and deposition during forest and grassland fires and to evaluate the working conditions of firemen. An increase of several orders of magnitude of the airborne radionuclide concentration was observed in the territory near the fire area. The resuspension factor for (137)Cs and (90)Sr was determined to range from 10(-6) to 10(-5) m(-1), and for the plutonium radionuclides from 10(-7) to 10(-6) m(-1) (related to the nuclides in the combustible biomass). These values are 2 orders of magnitude lower if they are calculated relatively to the total contamination density (including the nuclides in the soil). The radionuclide fallout along the plume axis is negligible in comparison to the existing contamination. However, the additional inhalation dose for firemen exposed in the affected area can reach the level of the additional external irradiation in the period of their mission. The plutonium nuclides constitute the dominating contribution to the inhalation dose.

Population models for the health effects of ionizing radiation.

In this paper we review recently-developed extension frailty, quadratic hazard, stochastic process, microsimulation, and linear latent structure models, which have the potential to describe the health effects of human populations exposed to ionizing radiation. We discuss the most common situations for which such models are appropriate. We also provide examples of how to estimate the parameters of these models from datasets of various designs. Carcinogenesis models are reviewed in context of application to epidemiologic data of population exposed to ionizing radiation. We also discuss the ways of how to generalize stochastic process and correlated frailty models for longitudinal and family analyses in radiation epidemiology.

[Carpal bones of the Chiroptera in the comparative-anatomical and functional aspects]. / Kist' Rukokrylykh v sravnitel'no-anatomicheskom i funktsional'nom aspektakh.

Data on investigation of hand sceletal bones carried out in eight genera of three families of bats were subjected to comparative-anatomical and functional analysis. Quantitatively, the hand sceletal bones of Chiroptera preserve constructive pattern general for the hand of terrestrial mammalians Pentadactilus. It has rudiments of the prefirst (Pp) and the seventh (Pm) rays. The latter is situated on the volar surface of the base Mc5. Scaphoid, semilunar and central carnal bones of Chiroptera, like those of Mototremata, some Marsupialia, Insectivorona and Carnivora merge together into one large bone--os lunatum. At the same time, the hand of Chiropter is a highly specialized structure, that is evident from the presence of articular restricotrs of anterior sagging of the wrist, crests and grooves directing movements in a strictly definite plane, from fan-like spreading and bringing together the rays, from very long metacarpal bones and proximal phalanges, from reduction of distal phalangs of the 3d and 5th fingers. Thus, the hand of Chiroptera is a unique example of combination of primitive, initial for pentadactule plantigrades wrist with signs of narrow specialization resembling, to some extent, those of Ungulata; only in Ungulata those signs developed on the base of digitigrades wrist.