A Spatial Inquiry into Childhood Lead Poisoning in Shelby County, Tennessee

Review of the recent literature suggests that integration of geographical information systems (GIS) into childhood lead exposure studies significantly enhances identifying lead hazards in the environment and determining at risk children. The purpose of this study is to find at-risk areas of childhood lead poisoning as well as determining risk factors in Shelby County, Tennessee. The two common deduplication methods: the first blood lead level (BLL) test result and the highest BLL test result were compared. Kappa statistic was used to investigate the effect of residential mobility on hot spots. Global and local spatial autocorrelations, Moran’s I and Getis and Ord’s Gi, were used to test the existence of global spatial autocorrelation as well as to find local pockets of high BLLs, and their trends. BLLs were grouped into four time periods during the 20 years between 1994 and 2013. Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) were used to model risk factors. Kappa agreement results indicated that residential mobility had an approximate effect of 10% agreement change for multiple-screened children. Spatial autocorrelation statistics indicate that there is a strong global spatial autocorrelation within the BLL dataset. Local statistics showed that local clusters of high BLLs are concentrated in the western part of the county in the first period: 1994-1998 and moved to a more disperse pattern towards the east and south. The global and local statistical models showed that there is a significant relationship between the percent of children with elevated blood lead levels (EBLLs) and the percent of screening, median construction year, old housing, median income, monthly rent, African American population, education attainment, public assistance, poverty, and median income. Population density and vacancy were not found to be associated with the percent of children with EBLLs

Heatwave Events and Mortality Outcomes in Memphis, Tennessee: Testing Effect Modification by Socioeconomic Status and Urbanicity

Heatwave studies typically estimate heat-related mortality and morbidity risks at the city level; few have addressed the heterogeneous risks by socioeconomic status (SES) and location within a city. This study aimed to examine the impacts of heatwaves on mortality outcomes in Memphis, Tennessee, a Mid-South metropolitan area top-ranked in morbidity and poverty rates, and to investigate the effects of SES and urbanicity. Mortality data were retrieved from the death records in 2008–2017, and temperature data from the Applied Climate Information System. Heatwave days were defined based on four temperature metrics. Heatwave effects on daily total-cause, cardiovascular, and respiratory mortality were evaluated using Poisson regression, accounting for temporal trends, sociodemographic factors, urbanicity, and air pollution. We found higher cardiovascular mortality risk (cumulative RR (relative risk) = 1.25, 95% CI (confidence interval): 1.01–1.55) in heatwave days defined as those with maximum daily temperature \u3e95th percentile for more than two consecutive days. The effects of heatwaves on mortality did not differ by SES, race, or urbanicity. The findings of this study provided evidence to support future heatwave planning and studies of heatwave and health impacts at a coarser geographic resolution

Evaluation of the awareness of the physicians on negligence and abuse of the elderly patients admitted to emergency department

Introduction: With the increase in the population of the elderly, the negligence and abuse of the elderly (NAE) is increasing at a great pace. Although the rates of NAE in the elderly admitted to emergency depart- ment (ED) is more than the estimated rates, the diagnosis and reporting of such cases are extremely rare. The primary aim of the present study is to evaluate the NAE status in the elderly admitted to ED, the awareness in ED physicians, the attitudes towards these cases and the knowledge levels in this field.  Methods: An electronic questionnaire form that was used as the data collection tool consisted of 19 ques- tions and 2 sections. To call for participation, the questionnaires used in the study were shared with the ED physicians in an online manner between December 2017 and April 2018. The data were analyzed with the SPSS 23.0 Windows computer program with definitive statistics.  Results: A total of 69.4% of the participants faced NAE and 30% did not report this; 79.8% of the partic- ipants stated that they had received training in this field and 9% stated that there was a screening test for the abuse of the elderly. A statistically significant difference was determined between those who received course training in this field and those who received training during medicine faculty education and specialist training.  Conclusions: In this study, it was observed that the NAE rates were more than the estimated rates in the elderly admitted to ED. It was understood that ED physicians did not have adequate knowledge in this field. A new curriculum is needed for the training and education in this field. 

Exploring childhood lead exposure through GIS: A review of the recent literature

The use of GIS in environmental risk factor studies on childhood lead exposure became a focus of research activity in the late 1990s. This prompted the CDC to develop a guideline for the use of GIS in childhood lead poisoning studies in 2004 [1]. Even though the number of children with elevated blood lead levels (EBLLs) in the U.S. is decreasing, eliminating EBLLs by the year 2020 remains a goal of the U.S. Department of Health and Human Services [2]. The capacity to achieve this goal is conditional on the ability to develop strategies based on geographic areas [3]. Funding is another factor to achieve this goal especially when health departments have limited budgets [4]. Despite significant research on the risk factors affecting childhood lead poisoning (age of housing, urban/rural status, race/ethnicity, socioeconomic status, population density, renter/owner occupancy, housing value, nutritional status), there has not been any review article discussing the GIS-based studies. The purpose of this article is to review previous and current GIS research to understand which methods currently employed have been most effective in the screening strategies and examining spatial epidemiology of childhood lead exposure. Another goal is to identify additional methods in GIS-utilized lead poisoning research that also provide public health practitioners and policy makers the ability to better target lead poisoning preventive interventions. Our review covers the time period from 1991 to 2012 and includes GIS-based studies which were published until the adoption of the toxicity threshold of blood lead levels of 5 microgram per-deciliter (µg/dL) by the CDC [5]

Outcomes of aggressive treatment in esophageal cancer patients with synchronous solitary brain metastasis

The aim of the present study was to investigate the outcomes of esophageal cancer (EC) patients with isolated synchronous brain oligometastasis (oligo-BM) treated with chemoradiotherapy (CRT) of the primary site and localized treatment of the BM with surgery, radiotherapy (RT) or radiosurgery. Of 125 EC patients investigated, seven patients (6%) had solitary BM. Six patients were diagnosed prior to, and one patient was diagnosed during, treatment. All patients were treated with neoadjuvant chemotherapy and whole-brain RT (WBRT) for BM. All but one patient received definitive CRT with a median RT dose of 50.4 Gy using conventional fractionation RT. The median age at diagnosis was 59 years (range, 48-77 years). Six patients succumbed to mortality, and one continued to receive systemic chemotherapy at the last visit. The median survival time of the patients was 18.9 months (range, 10.0-27.2 months). Median time to progression after completion of the treatments was 8 months (range, 3-9 months). Two patients had progression of the primary tumor, and one patient had progression of the BM. The neurological status of three patients with BM who were identified during the staging work-up did not deteriorate as a consequence of WBRT. In conclusion, the present study has demonstrated that aggressive treatment of the primary tumor and oligo-BM in patients with EC may prolong the survival time

Prognostic Value of Metabolic Response Measured by FDG-PET-CT in Patients with Breast Cancer Liver Metastasis Treated with Stereotactic Body Radiotherapy

OBJECTIVE To investigate the impact of metabolic response measured by 18-fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET-CT) in patients with breast cancer liver metastasis (BCLM) treated with stereotactic body radiotherapy (SBRT). METHODS The medical records of 17 patients with BCLM treated with SBRT between March 2013 and October 2017 were investigated retrospectively. Patients received SBRT for their liver metastasis, and thereafter, a second FDG-PET-CT was performed for response assessment in a median of 4.1 (2.2-8.2) months. A total of 54 Gy in three fractions were delivered to liver metastatic lesions. The standardized uptake value (SUV) and survival rates were evaluated. RESULTS After a median follow-up time of 11.5 (3.2-48.9) months, there was a significant difference between pre- and post-SBRT SUVs (p<0.001). Complete metabolic response was observed in 14 (82%) patients, partial metabolic response was observed in 2 (12%) patients, and stable metabolic disease/progressive metabolic disease was observed in 1 (6%) patient at post-treatment PET-CT. The 1- and 2-year overall survival rates were 68% and 57%, respectively, and the 1- and 2-year progression-free survival rates were 38% and 25%, respectively. CONCLUSION PET-CT is an effective tool for response monitoring in patients with BCLM treated with SBRT

Exploring the spatio-temporal dynamics of reservoir hosts, vectors, and human hosts of west Nile virus: A review of the recent literature

Over the last two decades West Nile Virus (WNV) has been responsible for significant disease outbreaks in humans and animals in many parts of the World. Its extremely rapid global diffusion argues for a better understanding of its geographic extent. The purpose of this inquiry was to explore spatio-temporal patterns of WNV using geospatial technologies to study populations of the reservoir hosts, vectors, and human hosts, in addition to the spatio-temporal interactions among these populations. Review of the recent literature on spatial WNV disease risk modeling led to the conclusion that numerous environmental factors might be critical for its dissemination. New Geographic Information Systems (GIS)-based studies are monitoring occurrence at the macro-level, and helping pinpoint areas of occurrence at the micro-level, where geographically-targeted, species-specific control measures are sometimes taken and more sophisticated methods of surveillance have been used. © 2013 by the authors; licensee MDPI, Basel, Switzerland

Is there any benefit of paraaortic field irradiation in pelvic lymph node positive endometrial cancer patients? A propensity match analysis

We evaluated the survival outcomes and recurrence patterns of endometrial cancer (EC) patients with pelvic lymph node metastases who received postoperative radiotherapy (RT) to the pelvis (P-RT) or to the pelvis plus paraaortic lymph nodes (PA-RT) with or without systemic chemotherapy (ChT). The data from 167 patients with stage IIIC1 EC treated with postoperative RT or RT and ChT were collected retrospectively. Those patients with pelvic lymph node metastases were treated with either P-RT (106 patients, 63%) or PA-RT (61 patients, 37%). The median follow-up time for the entire cohort was 49 (range = 5–199) months. The patients receiving adjuvant ChT and RT had significantly higher 5-year OS rates (77% vs. 33%, p < .001) and 5-year PFS rates (71% vs. 30%, p < .001) when compared to those receiving adjuvant RT alone. The patients receiving P-RT and ChT had significantly higher 5-year OS rates and 5-year PFS rates when compared to those treated with adjuvant PA-RT in the entire cohort and matched cohort. Adjuvant ChT together with RT is the strongest predictor of the OS and PFS. Prophylactic PA-RT is unnecessary, even if ChT is used together with P-RT in EC patients with pelvic lymph node metastasis.Impact statement What is already known on this subject? Local and distant recurrence risks are relatively higher in patients with stage IIIC disease, postoperative adjuvant treatment is required to reduce the recurrence risk. Adjuvant RT is a common approach for patients with locally advanced EC. Optimal target volume for RT in patients with stage IIIC EC remains controversial. We demonstrated that extended field RT is unnecessary, even if ChT is used together with pelvic RT in stage IIIC EC patients. What do the results of this study add? We demonstrated that adjuvant ChT together with RT is the strongest predictor of the OS and PFS for EC patients with pelvic lymph node metastases. Extended field RT is unnecessary, even if ChT is used together with pelvic RT in EC patients with pelvic lymph node metastases. What are the implications of these findings for clinical practice and/or further research? Although adjuvant treatment modalities are associated with improvements in survival, distant metastasis still remains the most common site of recurrence in advanced EC patients. Thus, further research is warranted to identify improved combined modality strategies to optimise the outcomes for EC patients with pelvic lymph node metastasis

Prognostic values of ADCmean and SUVmax of the primary tumour in cervical cancer patients treated with definitive chemoradiotherapy

We analysed the correlation of 18F-fluorodeoxyglucose uptake into primary tumours using the maximum standardised uptake value (SUVmax) and the mean apparent diffusion coefficient (ADCmean) values in magnetic resonance imaging (MRI) with the clinical and pathological factors in patients with cervical cancer who were treated with concurrent chemoradiotherapy. The patients were stratified according to the primary tumour pre-treatment ADCmean and SUVmax cut-off values. There were significant correlations between the SUVmax of the primary tumour and tumour size, and the treatment response. The correlation between the ADCmean and FIGO stage, tumour size, and the lymph node metastasis was significant. The SUVmax was significantly and inversely correlated with the ADCmean for cervical cancer (r = −0.44, p <.001). In the multivariate analysis, the primary tumour ADCmean, treatment response and the lymph node metastasis emerged as significant independent predictors of both OS and DFS, and of the primary tumour SUVmax for DFS. Tumour size has a borderline significance for OS. High SUVmax and low ADCmean of the primary tumour are important predictive factors for identifying high-risk patients with cervical cancer who are treated with definitive chemoradiotherapy. These results point to a future role for the diffusion-weighted MRI and for 18F-fluorodeoxyglucose positron emission tomography, not only in the staging of cervical cancer but as an aid in the selection of an adjuvant treatment regimen after chemoradiotherapy for individual patients.Impact statement What is already known on this subject? A negative correlation between primary tumour SUVmax derived from positron emission tomography (PET/CT) and ADCmin derived from diffusion weighted magnetic resonance imaging (DW-MRI) in various cancer types and cervical cancer has been demonstrated. However, the prognostic value of primary tumour SUVmax and ADCmean in cervical cancer patients treated with definitive chemoradiotherapy is not well studied yet. What the results of this study add? The patients with high-risk features (larger tumours, extensive stage, lymph node metastasis) had higher primary tumour SUVmax and lower ADCmean values. Primary tumour ADCmean and lymph node metastasis emerged as significant independent predictors of both overall and disease-free survival. This study demonstrated that the functional biomarkers delivered from PET-CT and DW-MRI are important in predicting the treatment outcomes in the squamous cell carcinoma of cervix treated with definitive chemoradiotherapy, where clinical and radiological findings are very important, since these patients are not staged surgically. What are the implications of these findings for clinical practice and/or further research? Based on these findings, there may be a future role of DW-MRI and FDG/PET-CT not only in the staging of cervical cancer but as an aid in the selection of an adjuvant treatment regimen after chemoradiotherapy (ChRT) for individual patients