Neoadjuvant Cisplatin-based Chemotherapy in Nonmetastatic Muscle-invasive Bladder Cancer: A Systematic Review and Pooled Meta-analysis to Determine the Preferred Regimen.

OBJECTIVE: To determine whether neoadjuvant gemcitabine and cisplatin (GC) vs dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) before radical cystectomy improves overall survival (OS), progression-free survival (PFS), and pathologic complete response (pCR) for patients with muscle-invasive bladder cancer with secondary analyses of pathological downstaging and toxicity. MATERIALS AND METHODS: This systematic review and meta-analysis identified studies of patients with muscle-invasive bladder cancer treated with neoadjuvant GC compared to ddMVAC from PubMed, Web of Science, and EMBASE. Random-effect models for pooled log-transformed hazard ratios (HR) for OS and PFS and pooled odds ratios for pCR and downstaging were developed using the generic inverse variance method and Mantel-Haenszel method, respectively. RESULTS: Ten studies were identified (4 OS, 2 PFS, and 6 pCR clinical endpoints). Neoadjuvant ddMVAC improved OS (HR 0.71 [95% confidence intervals 0.56; 0.90]), PFS (HR 0.76 [95% confidence intervals 0.60; 0.97]), and pathological downstaging (odds ratio 1.34 [95% confidence interval 1.01; 1.78]) as compared to GC. There was no significant difference between regimens for pCR rates (odds ratio 1.38 [95% confidence interval 0.90; 2.12]). Treatment toxicity was greater with ddMVAC. Limitations result from differences in number of ddMVAC cycles and patient selection between studies. CONCLUSION: Neoadjuvant ddMVAC is associated with improved OS and PFS vs gemcitabine/cisplatin for patients with muscle-invasive bladder cancer before radical cystectomy. Although rates of pathological complete response were not significantly different, pathological downstaging correlated with OS. ddMVAC should be preferred over gemcitabine/cisplatin for patients with muscle-invasive bladder cancer who can tolerate its greater toxicity.

Cost of upper tract imaging obtained during hematuria evaluation: Analysis of a national claims database.

INTRODUCTION: To investigate the actual cost of hematuria evaluation using nationally representative claims data, given that the workup for hematuria burdens the healthcare system with significant associated costs. We hypothesized that evaluation with contrast-enhanced computed tomography (CT) confers more cost to hematuria evaluation than renal ultrasound (US). METHODS: Using a national, privately insured database (MarketScan), we identified all individuals with an incident diagnosis of hematuria. We included patients who underwent cystoscopy and upper tract imaging within 3 months of diagnosis. We tabulated the costs of the imaging study as well as the total healthcare cost per patient. A multivariable model was developed to evaluate patient factors associated with total healthcare costs. RESULTS: We identified 318,680 patients with hematuria who underwent evaluation. Median costs associated with upper tract imaging were $362 overall, $504 for CT with contrast, $163 for US, $680 for magnetic resonance imaging (MRI), $283 for CT without contrast, and $294 for retrograde pyelogram. Median cystoscopy cost was $283. Total healthcare costs per patient were highest when utilizing MRI and CT imaging. When adjusted for comorbidities, the use of any imaging other than ultrasound was associated with higher costs. CONCLUSIONS: In this nationally representative analysis, hematuria evaluation confers a significant cost burden, while the primary factor associated with higher costs of screening was imaging type. Based upon reduced cost of US-based strategies, further investigation should delineate its cost-effectiveness in the diagnosis of urological disease.

Association of Frailty and Complications Following Prostate Biopsy: Results From a Population-Based, Privately Insured Cohort.

INTRODUCTION: Prostate needle biopsy (PNBx) is essential for prostate cancer diagnosis, yet it is not without risks. We sought to assess patients who underwent PNBx using a claims-based frailty index to study the association between frailty and postbiopsy complications from a large population-based cohort. We hypothesized that increased frailty would be associated with adverse outcomes. METHODS: Using Market Scan, we identified all men who underwent PNBx from 2010 to 2015. Individuals were stratified by claims-based frailty index into 2 prespecified categories: not frail, frail. Complications occurring within 30 days from prostate biopsy requiring emergency department, clinic, or hospital evaluations constituted the primary outcome. Unadjusted and adjusted analyses identified patient covariates associated with complications. RESULTS: We identified 193,490 patients who underwent PNBx. The mean age was 57.6 years (SD: 5.0). In all, 5% were prefrail, mildly frail, or moderately to severely frail. The rate of overall complications increased from 11.1% for not frail to 15.5% for frail men. After adjusting for covariates, individuals with any degree of frailty experienced a higher risk of overall complication (odds ratio [OR]: 1.29; P < .001), clinic (OR: 1.26; P < .001) and emergency department visits (OR: 1.32; P = .02), and hospital readmissions (OR: 1.41; P < .001). CONCLUSIONS: Frailty was associated with a higher risk of complications for patients undergoing PNBx. Frailty assessment should be integrated into shared decision-making to limit the provision of potentially harmful care associated with prostate cancer screening.

Disparities in Hospitalized Chronic Obstructive Pulmonary Disease Exacerbations Between American Indians and Non-Hispanic Whites.

BACKGROUND: The prevalence of chronic obstructive pulmonary disease (COPD) is high in American Indian (AI) populations, as are diabetes and obesity, which are common COPD comorbidities. However, COPD research among AI populations is limited. STUDY DESIGN AND METHODS: We conducted a retrospective study to investigate potential health disparities and risk factors among AI and non-Hispanic White (NHW) patients with COPD exacerbations hospitalized at the University of Oklahoma Medical Center between July 2001 and June 2020. Demographics, clinical variables, and outcomes were collected. RESULTS: A total of 76 AI patients and 304 NHW patients were included. AI patients had more comorbidities than did NHW patients (4.3 versus.3.1, p<0.001). In multiple variable analyses, AI race was associated with higher odds of needing intensive care unit (ICU) care ( odds ratio [OR], 2.37, 95% confidence interval [CI], 1.36--4.16, p=0.002) and invasive mechanical ventilator use (OR, 2.75, 95% CI, 1.42-5.29, p=0.002). AI race was also associated with longer ICU stays compared with NHWs (OR, 1.43, 95% CI, 1.18--1.73, p<0.001). The average number of days on mechanical ventilator support increased by 137.3% for an AI patient compared to an NHW patient (p<0.001). AI race was not associated with discharge to other health facilities (OR, 0.98, 95% CI, 0.52-1.83, p=0.944). INTERPRETATION: AI patients were more likely than NHW patients to need ICU care and ventilator support, have longer ICU stays, and more days on mechanical ventilator support. More studies are needed to identify reasons for these disparities and effective interventions to reduce them.

Floating Photovoltaic Systems: Assessing the Technical Potential of Photovoltaic Systems on Man-Made Water Bodies in the Continental United States.

Floating photovoltaic (FPV) systems, also called floatovoltaics, are a rapidly growing emerging technology application in which solar photovoltaic (PV) systems are sited directly on water. The water-based configuration of FPV systems can be mutually beneficial: Along with providing such benefits as reduced evaporation and algae growth, it can lower PV operating temperatures and potentially reduce the costs of solar energy generation. Although there is growing interest in FPV, to date there has been no systematic assessment of technical potential in the continental United States. We provide the first national-level estimate of FPV technical potential using a combination of filtered, large-scale datasets, site-specific PV generation models, and geospatial analytical tools. We quantify FPV co-benefits and siting considerations, such as land conservation, coincidence with high electricity prices, and evaporation rates. Our results demonstrate the potential of FPV to contribute significantly to the U.S. electric sector, even using conservative assumptions. A total of 24 419 man-made water bodies, representing 27% of the number and 12% of the area of man-made water bodies in the contiguous United States, were identified as being suitable for FPV generation. FPV systems covering just 27% of the identified suitable water bodies could produce almost 10% of current national generation. Many of these eligible bodies of water are in water-stressed areas with high land acquisition costs and high electricity prices, suggesting multiple benefits of FPV technologies.

Between the foreign and the local: French midwifery, traditional practitioners, and vernacular medical knowledge about childbirth in Lima, Peru.

This article examines the politics of midwifery and the persecution of untitled female assistants in childbirth in early republican Peru. A close reading of late colonial publications and the works of Benita Paulina Cadeau Fessel, a French obstetriz director of a midwifery school in Lima, demonstrates both trans-Atlantic and local influences in the campaign against untitled midwives. Cadeau Fessel's efforts to promote midwifery built upon debates among writers in Peru's enlightened press, who vilified untrained midwives' and wet nurses' vernacular medical knowledge and associated them with Lima's underclass. One cannot understand the transfer of French knowledge about professional midwifery to Peru without reference to the social, political, and cultural context.

Between the foreign and the local: French midwifery, traditional practitioners, and vernacular medical knowledge about childbirth in Lima, Peru / Entre o estrangeiro e o local: obstetrizes francesas, médicos tradicionais e conhecimento médico vernáculo sobre partos em Lima, Peru

This article examines the politics of midwifery and the persecution of untitled female assistants in childbirth in early republican Peru. A close reading of late colonial publications and the works of Benita Paulina Cadeau Fessel, a French obstetriz director of a midwifery school in Lima, demonstrates both trans-Atlantic and local influences in the campaign against untitled midwives. Cadeau Fessel's efforts to promote midwifery built upon debates among writers in Peru's enlightened press, who vilified untrained midwives' and wet nurses' vernacular medical knowledge and associated them with Lima's underclass. One cannot understand the transfer of French knowledge about professional midwifery to Peru without reference to the social, political, and cultural context.

Este artigo analisa as políticas de práticas de parteiras profissionais e a condenação de parteiras leigas nos primórdios do Peru republicano. A leitura atenta de publicações de fins do período colonial e dos trabalhos de Benita Paulina Cadeau Fessel, obstetriz francesa diretora de uma escola de parteiras em Lima, revela influência tanto transatlântica como local na campanha contra as parteiras sem titulação. Cadeau Fessel promovia seu ofício com base em debates veiculados na imprensa peruana ilustrada, que aviltavam o conhecimento tradicional de amas de leite e parteiras leigas e as associavam às classes desfavorecidas. Só é possível compreender a transferência do conhecimento francês sobre trabalho de parteiras profissionais para o Peru relacionando-a ao contexto social, político e cultural.

Scales of governance: the role of surveillance in facilitating new diplomacy during the 2009-2010 H1N1 pandemic.

The 2009-2010 H1N1 influenza pandemic has highlighted the importance of global health surveillance. Increasingly, global alerts are based on 'unexpected' 'events' detected by surveillance systems grounded in particular places. An emerging global governance literature investigates the supposedly disruptive impact of public health emergencies on mobilities in an interdependent world. Little consideration has been given to the varied scales of governance--local, national and global--that operate at different stages in the unfolding of an 'event', together with the interactions and tensions between them. By tracking the chronology of the H1N1 pandemic, this paper highlights an emergent dialogue between local and global scales. It also draws attention to moments of national autonomy across the global North and South which undermined the WHO drive for transnational cooperation.

Minocycline reduces articular cartilage damage following osteochondral injury.

INTRODUCTION: Secondary injury pathways activated after chondral and osteochondral injury represent a potential target for therapies designed to minimize articular cartilage loss. The primary objective of this study was to test the potential chondroprotective effects of intra-articular minocycline following osteochondral injury. METHODS: In vitro experiments were first performed with rabbit femoral condyles explants using an osteochondral drill injury model. Data from these in vitro experiments showed that minocycline at concentrations of 10-1000 nM decreased chondrocyte apoptosis in a dose-dependent manner. In vivo experiments were then conducted using the same injury model, studying the effects of intra-articular minocycline on chondrocyte apoptosis, chondrocyte cell number, and cartilage thickness. RESULTS: Four days after injury, minocycline delivered daily directly into the rabbit knee joints decreased acute chondrocyte apoptosis by 56% compared to controls. Analysis performed six weeks after injury demonstrated superior chondrocyte cell number, cartilage thickness, and cartilage repair in animals receiving short-term (one-week) minocycline treatment compared to controls. CONCLUSIONS: These data support a therapeutic approach utilizing drugs like minocycline for the acute treatment of osteochondral injuries.

Model of health? Distributed preparedness and multi-agency interventions surrounding UK regional airports.

The liberalisation of the European aviation sector has multiplied paths of entry into the United Kingdom (UK) for the international traveller. These changing mobilities necessitate a reconceptualisation of the border as a series of potentially vulnerable nodes occurring within, and extending beyond, national boundaries. In this paper, we consider the border through the lens of port health, the collective term for various sanitary operations enacted at international transport terminals. In the UK, a critical player in the oversight of port health is the Health Protection Agency (HPA), which became a non-Departmental public body in 2005. A major part of port health is preparedness, a set of techniques aimed at managing, and responding to, emergencies of public health concern. More recently, certain jurisdictions have embarked on public health preparedness work across a number of different geographical scales. Using methods pioneered by the military, this form of 'distributed preparedness' is of increased interest to social science and medical scholars. With reference to case studies conducted in localities surrounding two UK regional airports following the 2009-10 H1N1 influenza pandemic, we consider the extent to which distributed preparedness as a concept and a set of practices can inform current debates - in the UK, and beyond - concerning interventions at the border 'within'.

Airports, localities and disease: representations of global travel during the H1N1 pandemic.

During summer 2009, the UK experienced one of the highest incidences of H1N1 infection outside of the Americas and Australia. Building on existing research into biosecurity and the spread of infectious disease via the global airline network, this paper explores the biopolitics of public health in the UK through an in-depth empirical analysis of the representation of H1N1 in UK national and regional newspapers. We uncover new discourses relating to the significance of the airport as a site for control and the ethics of the treatment of the traveller as a potential transmitter of disease. We conclude by highlighting how the global spread of infectious diseases is grounded in particular localities associated with distinctive notions of biosecurity and the traveller.

Medicine and politics in colonial Peru: population growth and the Bourbon reforms / Pitt Latin American Studies

By the eighteenth century, Peru has witnessed the decline of its silver industry and massive population losses due to smallpox and other diseases. It was widely believed toward the century's end that economic salvation was contingent upon increasing the labor force and maintaining as many healthy workers as possible. In Medicine and politics in colonial Peru, Adan Warren presents a groundbreaking study of the primacy placed on medical care to generate population growth during this period. The Bourbon reforms of the eighteenth century shaped many of the political, economic, and social interests of Spain and its colonies. In Peru, local elites saw the reforms as an opportunity to positevely transform society and its conceptions of medicine and medical institutions. Creole physicians, in particular, took advantage of Bourbon reforms to wrest control of medical treatment away from the Catholic Church, establish their own control of medical treatment away from secular medical culture. But during the early years of independence, the doctos lost much of their influence, and medical reforms ground to a halt. As Warren's study reveals, despite falling in and out of political favor, Bourbon reforms and creole physicians were instrumental to the founding of modern medicine in Peru. (AU)

An operation for evangelization: Friar Francisco González Laguna, the cesarean section, and fetal baptism in late colonial Peru.

By publishing a medical-theological treatise in 1781, Friar Francisco González Laguna of Lima initiated a campaign to train Andean priests to perform postmortem cesarean sections for the purpose of baptizing the fetus. Linking González Laguna's text to European works on cesarean sections and Peruvian decrees ordering priests to train in surgery, this paper argues the friar saw the operation's utility as extending beyond saving unborn souls. Writing in the aftermath of indigenous and peasant uprisings, he argued the procedure constituted a tool for defeating the devil's presence in the Andes and carrying out evangelization, teaching parishioners by pious example.

An operation for evangelization Friar Francisco González Laguna, the cesarean section, and fetal baptism in late colonial Peru

By publishing a medical-theological treatise in 1781, Friar Francisco González Laguna of Lima initiated a campaign to train Andean priests to perform postmortem cesarean sections for the purpose of baptizing the fetus. Linking González Laguna's text to European works on cesarean sections and Peruvian decrees ordering priests to train in surgery, this paper argues the friar saw the operation's utility as extending beyond saving unborn souls. Writing in the aftermath of indigenous and peasant uprisings, he argued the procedure constituted a tool for defeating the devil's presence in the Andes and carrying out evangelization, teaching parishioners by pious example.

La medicina y los muertos en Lima: conflictos sobre la reforma de los entierros y el significado de la piedad católica, 1808-1850 / The medicine and the deads in Lima: conflicts about the reform of the burials and the meaning of the catholic mercy, 1808-1850

Em mayo de 1808, médicos criollos, autoridades eclesiásticas y oficiales del gobierno irrupieron en nombre de la salud pública, como nunca se había hecho antes, en las prácticas religiosas y en la vida ritual de la cultural y éticamente diversa población de Lima. Citando una serie de decretos reales emitidos en Madrid y que no eran cumplidos en Lima, y una creciente y novedosa literatura médica sobre los riesgos de continuar permitiendo los entierros al interior de las iglesias, las autoridades virreinales construyeron un cemiterio público en los extramuros de la ciudad de Lima. Más aún, demandaron que las prácticas funerarias y los entierros acataran estríctas pautas que fueron acordes con la higiene pública. [AU]

La medicina y los muertos en Lima: conflictos sobre la reforma de los entierros y el significado de la piedad católica, 1808-1850 / The medicine and the deads in Lima: conflicts about the reform of the burials and the meaning of the catholic mercy, 1808-1850

Em mayo de 1808, médicos criollos, autoridades eclesiásticas y oficiales del gobierno irrupieron en nombre de la salud pública, como nunca se había hecho antes, en las prácticas religiosas y en la vida ritual de la cultural y éticamente diversa población de Lima. Citando una serie de decretos reales emitidos en Madrid y que no eran cumplidos en Lima, y una creciente y novedosa literatura médica sobre los riesgos de continuar permitiendo los entierros al interior de las iglesias, las autoridades virreinales construyeron un cemiterio público en los extramuros de la ciudad de Lima. Más aún, demandaron que las prácticas funerarias y los entierros acataran estríctas pautas que fueron acordes con la higiene pública.

Piety and danger: popular ritual, epidemics, and medical reforms in Lima, Peru, 1750-1860

It examines reforms of funeral and burial practices in late-colonial and early-republican Lima, Peru, as part of a broader modernizing public health campaign led by representatives of the Bourbon Crown, local doctors, and natural philosophers.(AU)

Piedad barroca, epidemias, y las reformas funerarias y de entierro en las iglesias limeñas, 1808-1850 / Baroque piety, epidemics, and burial reforms in the churches of Lima, 1808-1850

Examina el discurso y debate entre los médicos y filósofos naturales peruanos con respecto a las prácticas funerarias. Igualmente, explica la resistencia de ciertos sectores de la población a las medidas de higiene pública, especialmente de parte de la población Afro-Peruana y quienes creían que los entierros en o cerca de las iglesias eran necesarios para que las almas escapasen del purgatorio.(AU)