Warren County, Kentucky Hazardous Materials Commodity Flow Analysis

This report presents the results of a Commodity Flow Analysis of Hazardous Materials for I-65 and the William H. Natcher Parkway conducted by Western Kentucky University in partnership with the Warren County (Kentucky) Local Emergency Planning Committee (LEPC). Kentucky counties within the study area include Warren, Simpson, Edmonson, Butler, Barren, and Hart. Figure 1 shows the sections of I-65 and Natcher Parkway that run through these counties. The purpose of our report is to give information on patterns of hazardous materials being transported along I-65 and Natcher Parkway as observed from May 24th 2010 to June 18th 2010. A secondary purpose is to summarize incidents involving hazardous materials over the previous ten years (January 2001-2009). Finally, this report assesses survey information collected from fixed facilities that ship and receive hazardous materials in the I-65 and Natcher Parkway corridors. Commodity flow analysis is necessary in order for the LEPC to prepare for future hazardous material releases that may occur along this section of I-65 and Natcher Parkway. Data collected from this study will aid the emergency planning process for specific hazardous materials that were observed to frequent the study area during the study period

Disparities in adherence to breast cancer care

Improvements in screening and treatment methods have resulted in a growing number of breast cancer survivors in the United States. Recognizing factors that influence breast cancer management practices among minority or immigrant women is as crucial as examining how these factors may differ within various racial/ethnic groups of populations. The goal of this dissertation was to examine disparities (by both race/ethnicity and acculturation) in receipt of breast cancer management (both treatment and survivorship care). The specific aim of my first paper was to examine disparities by level of acculturation in the receipt of breast cancer treatment (type of surgery: mastectomy versus breast conserving surgery) and nonadherence to NCCN guidelines for breast cancer survivorship care among female Mexican American breast cancer patients receiving treatment at the MD Anderson Cancer Center and enrolled in the Ella Binational Breast Cancer Study. In the second study, we conducted a systematic review of literature to discuss and critique studies examining racial/ethnic disparities in the use of surveillance mammograms among breast cancer survivors. Although, the association reached borderline level of statistical significance, we found that more acculturated women were less likely to receive a mastectomy (compared to breast conserving surgery) as their primary surgical treatment towards breast cancer. Additionally, these women had lower odds of nonadherence to survivorship care (both surveillance mammograms and clinic visits), although, this association was statistically non-significant. Our systematic review identified 22 unique studies that addressed racial and ethnic disparities in use of surveillance mammogram among breast cancer survivors. Overall, we found statistically significant racial/ethnic disparities in use of surveillance mammogram in thirteen (of 22) studies, with non-White women significantly less likely to receive timely surveillance mammogram compared to Whites for a majority of studies. This research suggests that disparities in receipt of breast cancer care (both treatment and survivorship care) exist, not only by race/ethnicity but also by different levels of acculturation. Future interventions need to focus on providing better guidance to the minority & immigrant patients with their treatment related decisions, as well as improve patient retention in cancer survivorship care

Pharmacological management of cachexia in adult cancer patients: a systematic review of clinical trials

Abstract Background Cachexia is a multisystem syndrome characterized by weight loss, anorexia, loss of muscle mass, systemic inflammation, insulin resistance, and functional decline. Management of cachexia involves addressing multiple underlying biological mechanisms. Previous review on pharmacological management of cancer cachexia identified progestins and corticosteroids as effective agents for treatment of cachexia. However, to date no consensus exists on a single effective or standard treatment for management of cachexia. The aim of this systematic review is to determine the effectiveness of pharmacological treatments used to manage cachexia among adult cancer patients. Methods We performed literature searches of PubMed (NLM), Embase (Ovid), and Medline(Ovid) to identify clinical trials focused on pharmacological management of cancer cachexia among adult cancer patients from 2004 to 2018. Three reviewers screened a random selection of abstracts to measure for interrater reliability. After this step, each screener screened two-thirds of all abstracts and 177 studies were identified for full text review. The primary outcome was impact of pharmacological management on change in either weight or lean body mass in cancer patients. Results We identified 19 articles (representing 20 RCTs) that focused on pharmacological management of cancer cachexia. Agents showing promising results included Anamorelin and Enobosarm. Anamorelin at 50 or 100 mg per day for 12 weeks showed a consistent benefit across all studies and resulted in significant improvement in weight as compared to baseline among cancer patients. Enobosarm at 1 and 3 mg per day was also effective in improving lean body mass and QOL symptoms among advancer stage cancer patients. Finally, use of combination agents provide evidence for targeting multiple pathways underlying cachexia mechanism to achieve maximum benefit. No agents showed functional improvement in cancer patients. Conclusion Anamorelin as a single agent shows promising results in improving cachexia related weight loss among cancer patients. Further research on combination therapies may be helpful to address critical gaps in cachexia management

Clinical, Pathological, and Molecular Characteristics of CpG Island Methylator Phenotype in Colorectal Cancer: A Systematic Review and Meta-analysis

BACKGROUND: CpG island methylator phenotype (CIMP) tumors, comprising 20% of colorectal cancers, are associated with female sex, age, right-sided location, and BRAF mutations. However, other factors potentially associated with CIMP have not been robustly examined. This meta-analysis provides a comprehensive assessment of the clinical, pathologic, and molecular characteristics that define CIMP tumors. METHODS: We conducted a comprehensive search of the literature from January 1999 through April 2018 and identified 122 articles, on which comprehensive data abstraction was performed on the clinical, pathologic, molecular, and mutational characteristics of CIMP subgroups, classified based on the extent of DNA methylation of tumor suppressor genes assessed using a variety of laboratory methods. Associations of CIMP with outcome parameters were estimated using pooled odds ratio or standardized mean differences using random-effects model. RESULTS: We confirmed prior associations including female sex, older age, right-sided tumor location, poor differentiation, and microsatellite instability. In addition to the recognized association with BRAF mutations, CIMP was also associated with PIK3CA mutations and lack of mutations in KRAS and TP53. Evidence of an activated immune response was seen with high rates of tumor-infiltrating lymphocytes (but not peritumoral lymphocytes), Crohn-like infiltrates, and infiltration with Fusobacterium nucleatum bacteria. Additionally, CIMP tumors were associated with advance T-stage and presence of perineural and lymphovascular invasion. CONCLUSION: The meta-analysis highlights key features distinguishing CIMP in colorectal cancer, including molecular characteristics of an active immune response. Improved understanding of this unique molecular subtype of colorectal cancer may provide insights into prevention and treatment

Impact of acculturation on breast cancer treatment and survivorship care among Mexican American patients in Texas

PurposeGiven the increasing number and diversity of cancer survivors in the USA and persistent racial/ethnic disparities in breast cancer care, we sought to examine the role of acculturation in adherence to recommended surgical treatment and survivorship care recommendations.MethodsStudy participants included 343 Mexican American women with stage I to III breast cancer who participated in the Ella Binational Breast Cancer Study and were treated at The University of Texas MD Anderson Cancer Center in Houston, Texas, between March 2007 and June 2011. Participants completed a questionnaire measuring acculturation, and clinical and demographic variables were obtained from an institutional database. Multivariable logistic regression models were constructed to examine differences in surgical procedures received and adherence to long-term survivorship care by acculturation level.ResultsBilingual (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 0.85-4.02, P = .11) and English-dominant women (OR = 2.39; 95% CI = 1.02-5.61, P = .04) were more likely to receive breast-conserving surgery (versus mastectomy) than were Spanish-dominant women. Among all patients, adherence to surveillance mammography and clinic visits decreased over time; the decline in clinic visit adherence was statistically significant (P = .005). Although no statistically significant association was found between acculturation and adherence to long-term survivorship care, receipt of breast-conserving surgery (versus mastectomy) was significantly associated with higher adherence to surveillance mammograms.ConclusionAcculturation may play a role in decision-making about surgical management of breast cancer, and further studies with larger samples are needed to explore its role in adherence to survivorship care recommendations. Findings from this study may help identify patients requiring additional support while making decisions pertaining to their cancer treatment and survivorship care

Financial strain and cancer risk behaviors among African Americans

BACKGROUND: African Americans suffer disproportionately from the adverse consequences of behavioral risk factors for cancer relative to other ethnic groups. Recent studies have assessed how financial strain might uniquely contribute to engagement in modifiable behavioral risk factors for cancer, but not among African Americans. The current study examined associations between financial strain and modifiable cancer risk factors (smoking, at-risk alcohol use, overweight/obesity, insufficient physical activity, inadequate fruit and vegetable intake, and multiple risk factors) among 1,278 African American adults (age, 46.5 ± 12.6 years; 77% female) and explored potential mediators (stress and depressive symptoms) of those associations. METHODS: Logistic regression models were used to examine associations between financial strain and cancer risk factors. Analyses were adjusted for age, sex, partner status, income, educational level, and employment status. Analyses involving overweight/obesity status additionally controlled for fruit and vegetable intake and physical activity. Nonparametric bootstrapping procedures were used to assess mediation. RESULTS: Greater financial strain was associated with greater odds of insufficient physical activity (P < 0.003) and smoking (P = 0.005) and was positively associated with the total number of cancer risk factors (P < 0.0001). There was a significant indirect effect of both stress and depressive symptoms on the relations of financial strain with physical inactivity and multiple risk factors, respectively. CONCLUSIONS: Future interventions aimed at reducing cancer disparities should focus on African Americans experiencing higher financial strain while addressing their stress and depressive symptoms. IMPACT: Longitudinal studies are needed to assess the temporal and causal relations between financial strain and modifiable behavioral cancer risk factors among African Americans