Spatial clusters of life expectancy and association with cardiovascular disease mortality and cancer mortality in the contiguous United States: 1980-2014

The average life expectancy varies greatly from county to county in USA and there are also spatial variations in the county mortality rates for cardiovascular disease (CVD) and cancer, the top two causes of death. An association between these two groups of diseases has not been identified by cluster analysis previously. The main objective in this study was to investigate and quantify the associations between mortality due to CVD, cancer mortality and life expectancy based on US county data between 1980 and 2014. Regression analysis was used to adjust life expectancy for the mortality due to CVD and that due to cancer. In addition to the spatial life expectancy trends, we also studied existing trends over time with the software JOINPOINT to see how life expectancy is influenced by changes in mortality due to CVD and cancer mortality. The study setting was the 48 contiguous US states, while participants were 3,100 counties and their populations of all ages during the period 1980-2014. The main outcomes are spatial clusters of unusually low or high levels of life expectancy in addition to identifying which county level life expectancy locations were significantly associated with mortality due to CVD and/or cancer. Life expectancy has been improving steadily from 1980 to 2014, but the rate of increase per year (indicated by variation of the trend slope) changed significantly at five joinpoints, the latest of which occurred in 2010 when the slope changed from 0.29 (1980-1982) to 0.03 (2010-2014). Our results reveal that there are significant, purely spatial clusters in some geographical areas where life expectancy rates are significantly higher (or lower) than in the rest of the contiguous US. It is also shown that there is a significant association between the life expectancy level and the corresponding CVD mortality, and there is also a significant association between life expectancy level and the corresponding overall cancer mortality. The general trends (regression slopes) over time for the USA in life expectancy mortality, CVD mortality and cancer mortality have changed significantly after 2009-2010

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The Spatial Analysis of the Malicious Uniform Resource Locators (URLs): 2016 Dataset Case Study

In this study, we aimed to identify spatial clusters of countries with high rates of cyber attacks directed at other countries. The cyber attack dataset was obtained from Canadian Institute for Cybersecurity, with over 110,000 Uniform Resource Locators (URLs), which were classified into one of 5 categories: benign, phishing, malware, spam, or defacement. The disease surveillance software SaTScanTM was used to perform a spatial analysis of the country of origin for each cyber attack. It allowed the identification of spatial and space-time clusters of locations with unusually high counts or rates of cyber attacks. Number of internet users per country obtained from the 2016 CIA World Factbook was used as the population baseline for computing rates and Poisson analysis in SaTScanTM. The clusters were tested for significance with a Monte Carlo study within SaTScanTM, where any cluster with p < 0.05 was designated as a significant cyber attack cluster. Results using the rate of the different types of malicious URL cyber attacks are presented in this paper. This novel approach of studying cyber attacks from a spatial perspective provides an invaluable relative risk assessment for each type of cyber attack that originated from a particular country

Patterns of Pediatric Cancers in Florida: 2000–2015

This study identifies pediatric cancer clusters in Florida for the years 2000–2015. Unlike previous publications on pediatric cancers in Florida, it draws upon an Environmental Protection Agency dataset on carcinogenic air pollution, the National Air Toxics Assessment, as well as more customary demographic variables (age, sex, race). The focus is upon the three most widely seen pediatric cancer types in the USA: brain tumors, leukemia, and lymphomas. The covariates are used in a Poisson regression to predict cancer incidence. The adjusted cluster analysis quantifies the role of each covariate. Using Florida Association of Pediatric Tumor Programs data for 2000–2015, we find statistically significant pediatric cancer clusters, but we cannot associate air pollution with the cancer incidence. Supplementary materials for this article are available online

Normoglycemia may encompass two subpopulations with respect to vascular risk in non-obese Caucasian women

Blood was collected from 206 non-obese normoglycemic Caucasian women who were not on cholesterol modifying therapy. A series of 23 biochemical markers were assayed for each participant, and the means of each laboratory test were compared across the 2 groups. We found that the groups with higher fasting plasma glucose (FPG) had a greater proportion of subjects with high risk levels for total and LDL cholesterol. We also found a significant statistical relationship between WBC and low density lipoprotein (LDL) for younger women with higher FPG but not for any other group. Levels of FPG between 90 to 99 mg/dL is associated with an increase in LDL cholesterol and mild inflammation in non-obese Caucasian women, suggesting that FPG in the upper normal range might be associated with a small risk for atherosclerosis. This is particularly relevant for younger women with higher FPG levels.Journal ArticleFinal article publishe

A spatial study of bladder cancer mortality and incidence in the contiguous US: 2000-2014

Bladder cancer is a significant health issue across the United States of America (USA). Evidence of unequal distribution of a disease or condition's incidence and mortality would suggest that important geographically-defined variables may play a role. In this study, a spatial cluster analysis of bladder cancer mortality identified significant hot spots in some parts of the USA. Regression analysis modelling estimated the effects of selected covariates or risk factors for bladder cancer mortality and also incidence. Spatial heat maps and cluster identification were done for mortality and incidence. The main result was the significant association between bladder cancer mortal-ity and arsenic intake from well water. A similar result was also obtained for cancer incidence and arsenic. Additionally, there are certain geographic areas that appear to have bladder cancer mortality rates beyond the simple association with the studied covariates. These geographic areas warrant further investigation to better under-stand why cancer mortality is unusually high in such geographic areas and to potentially identify additional local concerns or needs to further address bladder cancer mortality in those specific sites.Journal ArticleFinal article publishe

Ascertaining Performance Variables for Use in Determining Students’ Grades in Courses Employing a Business Simulation

Thus the purpose of this study was to better understand what variables, or combination of variables, that account for the major portion of variation in student performance in business simulations. The eight performance variables that were chosen for this study were selected because of their frequency of use in prior studies. Furthermore, since many simulations are started up in an in—process mode or are continued over more than one semester, the positive percent of change in these variables were included in the research design. Thus the study examined a total of sixteen simulation performance variables. These variables and their corresponding positive percent of change used in the study are sales, net income, ROS, ROE, ROA, dividends, market share, and stock value

Spatial and space-time clusters of brain tumor and CNS incidence and mortality in the contiguous USA: 2000-2014

Objective: Investigate geographical variations in brain/central nervous system (CNS) cancer incidence and mortality, and test associations between covariates and brain/CNS cancer for the years 2000–2014 in the contiguous USA. Methods: The disease surveillance software (SaTScanTM) was used to measure observable geographical variation in brain/CNS cancer incidence and mortality rates and identify and test spatial and space-time clusters with elevated relative risk. The analysis was done with age-adjusted brain/CNS cancer mortality and incidence counts data, including ICD codes C710–C719, C379, C740–C749, and C750–C759. The cancer data were then adjusted for covariates or risk factors, such as obesity, smoking, poverty, race, arsenic, air pollution, land pollution, water pollution, gender, health insurance, diabetes, glyphosate, superfund site density, and proximity to nuclear power plants. Results: Several significant spatial clusters of brain/CNS cancer exist for incidence in the Northeast and the Northwest, while spatial mortality clusters cover additional parts of the US. There also exist several significant space-time clusters for incidence and mortality. Conclusions: There exist significant and non-random brain/CNS cancer incidence and mortality clusters after adjusting for multiple covariates or risk factors. The thirteen covariates studied can assist in a better understanding of possible associations in geographical areas where the incidence or mortality rates are higher than expected. There is a significant association between several of the studied risk factors and the incidence rates of brain/CNS cancers, and the mortality rates. These results have the potential to provide a scientific framework that is based on surveillance, allowing health agencies to intervene to try to reduce the elevated rates of brain/CNS cancer in some parts of the contiguous US.Journal ArticleFinal article publishe

Geographic clusters of Alzheimer's Disease mortality rates in the USA: 2008-2012

Importance: The results identified geographic clusters of high and low Alzheimer's disease (AD)-related mortality across the contiguous United States. These clusters identify specific geographic groupings of counties that allow researchers to narrow the focus to identify some of the biopsychosocial variables contributing to increased or decreased AD mortality. Objectives: To determine the extent to which geographic clusters exist where AD mortality significantly differs from the national average. Such knowledge could further future research in a more focused study of variables that are contributing to these differences. Design: Age adjusted AD mortality rates were analyzed with a spatial cluster analysis using the disease surveillance software SatScanTM. Results: Three large clusters had elevated age-adjusted AD mortality of at least 60% above the national average. These clusters were in Washington State, Iowa, and North and South Dakota. Below average AD mortality was observed in several areas including New York City, and parts of Arizona, California, Arkansas and Texas. Conclusion and Relevance: This study demonstrates the use of disease surveillance methodology in identifying geographic patterns of unusually high or low AD mortality rates in the USA. Such results provide supporting evidence of appropriate locations to test interventions with the goal to reduce AD mortality.Journal Articl