Abstract
Introduction: Lack of health insurance is an important determinant of cancer health disparities in the United States. For patients with hematologic malignancies, breakthroughs in novel ...chemotherapeutics, targeted therapies, and stem cell transplantation are counterbalanced with concerns for financial toxicity and lack of access without adequate health coverage. Our objective was to measure racial differences in uninsured rates among patients with hematologic malignancies in states with and without Medicaid expansion under the Affordable Care Act.
Methods: We conducted a hospital-based retrospective cohort study of adults aged 40-64 years diagnosed with hematologic malignancies (lymphoma, multiple myeloma, leukemia, and Waldenstrom macroglobulinemia) between 2007 and 2016 using the National Cancer Database (NCDB). We collected information on demographics, clinical characteristics, insurance coverage, socioeconomic factors, and state Medicaid expansion status. We grouped Medicaid expansion states as: (i) non-expansion states, (ii) early expansion states (2010-2013), and (iii) late expansion states (2014-2016). Covariate adjusted difference-in-differences (DID) analyses were performed to determine changes in the percentage of uninsured hematologic malignancy patients over time. In modified Poisson regression models, we calculated adjusted rate ratios (RR) and 95% confidence intervals to identify disparities in uninsured rates among black, Hispanic, and Asian/Pacific Islander (API) patients compared to white patients by time period and Medicaid expansion.
Results: An overall cohort of 338,353 hematologic malignancy patients (median age: 56 years; 43% female) residing in Medicaid non-expansion (n=124,875), early expansion (n=60,305) and late expansion (n=153,173) states were included. Compared to 2007-2009, the proportion of uninsured patients was lower in 2014-2016 across all states; however, more substantial decreases in percentage uninsured occurred in states with Medicaid expansion (4.9% to 2.5%, diff 2.4%) versus states without expansion (9.4% to 8.3%, diff 1.1%; DID -1.3, P<0.01). These reductions were consistent among white (DID -1.1, P<0.01) and Hispanic (DID -4.3, P<0.01) patients; however, decreases in uninsured rates among black (DID -0.3, P=0.67) and API (DID 1.9, P=0.41) patients were not statistically significant. Regardless of expansion status, racial disparities persisted over time with racial and ethnic minority patients having a 1.5- to 3.0-fold higher likelihood of being uninsured compared to white patients.
Conclusions: Our study found that the proportion of uninsured hematologic malignancy patients in the NCDB decreased between 2007 and 2016, but this reduction was significantly greater in states with Medicaid expansion. We also identified racial disparities where black and API patients experienced minimal decreases attributed to Medicaid expansion and black, Hispanic, and API patients were consistently more likely to be uninsured over time.
This abstract is also being presented as Poster A115.
Citation Format: Gregory S. Calip, Naomi Y Ko, Karen I. Sweiss, Pritesh R. Patel, Brian C.-H. Chiu. Racial disparities in health insurance status of U.S. adults with hematologic malignancies in states with and without Medicaid expansion: Analyses from the National Cancer Database, 2007-2016 abstract. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr PR09.
Summary Objective The purpose of this study was to examine the oropharyngeal cancer pattern among different ethnic groups in Taiwan. Methods The sample population was divided into three ethnic ...groups: the Fukkien, Hakka, and aboriginal communities. Age-standardized mortality rates (SMRs) and age-standardized incidence rates (SIRs) were estimated among these ethnic groups for the period 1979–1996/1997. Results Our study found that the higher oropharyngeal cancer mortality and incidence rates in females of aboriginal groups are statistically significant, and higher than reference groups for both genders ( SMR = 3.76 , SIR = 2.18 ). However, in the lower areca quid chewing aboriginal groups, the higher pattern was not seen in females, and the lower pattern was even found in males. The incidence and mortality rate of oropharyngeal cancer in Hakkas was significantly lower than in the reference group. Conclusions The pattern of oropharyngeal cancer in Taiwan showed ethnic differences. The differences may be due to variation in exposure to different risk factors; however, in our study, we found that genetic differences might also be considered when explaining the different oropharyngeal cancer patterns among ethnic groups.
Early identification of the abnormal fetal brain vascularization and blood flow is very important, because the deficient perfusion of the fetal brain may be related to a poor prognosis of the central ...nervous system (CNS) development. To assess the fetal brain vascularization and the blood flow in normal gestation, we measured the fetal brain vascularization and the brain blood flow in normal fetuses using three-dimensional (3-D) power Doppler ultrasound (US) and the quantitative 3-D power Doppler histogram analysis. This study was undertaken by a prospective and cross-sectional design. In total, 155 normal singletons with gestational age (GA) between 21 and 40 weeks were included. The 3-D power Doppler US and the quantitative 3-D histogram analyses were used to assess the fetal brain vascular indexes,
i.e., vascularization index (VI), flow index (FI) and vascularization-flow index (VFI), in each case. Our results revealed that all the fetal brain VI, FI and VFI increased significantly with GA (all
p < 0.001). In addition, the fetal brain VI, FI and VFI were all significantly correlated with the common fetal growth indices, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight. Our study indicates that fetal brain vascularization and blood flow increase significantly with the advancement of GA as well as the fetal common growth indices during normal gestation. We believe our data may serve as a reference for further studies of the fetal brain blood flow in abnormal conditions. (E-mail: fchang@mail.ncku.edu.tw)
Abstract Simultaneous heart and kidney transplantation (SHKT) has become an accepted therapeutic option for patients with end-stage heart failure associated with end-stage renal disease. The ...immunosuppressive therapy is usually based upon a heart transplantation protocol using a calcineurin inhibitor (CNI). Sirolimus (SRL) is a potent nonnephrotoxic immunosuppressant with antiproliferative activity in nonimmune cells. Its use has recently been reported to show less nephrotoxicity among both heart and kidney transplants. However, the data for the SHKT are limited. We retrospectively examined the causes of 5 patients who received combined SRL-CNI immunosuppressive therapy with reduced CNI doses from 2003 to 2009. There was no mortality during follow-up. Two of the 3 patients who received a conversion regimen recovered renal function. One who suffered severe proteinuria after transplantation proceeded to hemodialysis at 3 years after conversion. Both of the patients who received the combined regimen de novo remained stable regarding their renal function. Cardiac function was stable in these patients; there was neither allograft rejection nor allograft coronary vasculopathy. We observed that patients without dyslipidemia or hyperuricemia before SHKT were less likely to develop these disorders under the combined regimen. Early medical intervention after close follow-up of lipid and uric acid values by dose adjustments resulted in a stable status of our patients.
An overview of KSTAR results Oh, Y.K.; Park, K.R.; Kim, Y.S. ...
Nuclear fusion,
10/2013, Letnik:
53, Številka:
10
Journal Article
Recenzirano
Since the first H-mode discharges in 2010, the duration of the H-mode state has been extended and a significantly wider operational window of plasma parameters has been attained. Using a second ...neutral beam (NB) source and improved tuning of equilibrium configuration with real-time plasma control, a stored energy of Wtot ∼ 450 kJ has been achieved with a corresponding energy confinement time of τE ∼ 163 ms. Recent discharges, produced in the fall of 2012, have reached plasma βN up to 2.9 and surpassed the n = 1 ideal no-wall stability limit computed for H-mode pressure profiles, which is one of the key threshold parameters defining advanced tokamak operation. Typical H-mode discharges were operated with a plasma current of 600 kA at a toroidal magnetic field BT = 2 T. L-H transitions were obtained with 0.8-3.0 MW of NB injection power in both single- and double-null configurations, with H-mode durations up to ∼15 s at 600 kA of plasma current. The measured power threshold as a function of line-averaged density showed a roll-over with a minimum value of ∼0.8 MW at . Several edge-localized mode (ELM) control techniques during H-mode were examined with successful results including resonant magnetic perturbation, supersonic molecular beam injection (SMBI), vertical jogging and electron cyclotron current drive injection into the pedestal region. We observed various ELM responses, i.e. suppression or mitigation, depending on the relative phase of in-vessel control coil currents. In particular, with the 90° phase of the n = 1 RMP as the most resonant configuration, a complete suppression of type-I ELMs was demonstrated. In addition, fast vertical jogging of the plasma column was also observed to be effective in ELM pace-making. SMBI-mitigated ELMs, a state of mitigated ELMs, were sustained for a few tens of ELM periods. A simple cellular automata ('sand-pile') model predicted that shallow deposition near the pedestal foot induced small-sized high-frequency ELMs, leading to the mitigation of large ELMs. In addition to the ELM control experiments, various physics topics were explored focusing on ITER-relevant physics issues such as the alteration of toroidal rotation caused by both electron cyclotron resonance heating (ECRH) and externally applied 3D fields, and the observed rotation drop by ECRH in NB-heated plasmas was investigated in terms of either a reversal of the turbulence-driven residual stress due to the transition of ion temperature gradient to trapped electron mode turbulence or neoclassical toroidal viscosity (NTV) torque by the internal kink mode. The suppression of runaway electrons using massive gas injection of deuterium showed that runaway electrons were avoided only below 3 T in KSTAR. Operation in 2013 is expected to routinely exceed the n = 1 ideal MHD no-wall stability boundary in the long-pulse H-mode ( 10 s) by applying real-time shaping control, enabling n = 1 resistive wall mode active control studies. In addition, intensive works for ELM mitigation, ELM dynamics, toroidal rotation changes by both ECRH and NTV variations, have begun in the present campaign, and will be investigated in more detail with profile measurements of different physical quantities by techniques such as electron cyclotron emission imaging, charge exchange spectroscopy, Thomson scattering and beam emission spectroscopy diagnostics.
Endothelial cells form gap junctions that, according to vessel type, may be composed of up to 3 types of connexin, connexin37, connexin40, and connexin43. Although changes in connexin expression have ...been linked to growth and injury in cultured endothelial cells, information on connexin expression in regenerating endothelium in situ is lacking. We investigated gap junction distribution and expression of all 3 endothelial connexins during healing in rat carotid artery after denudation injury. En face viewing of the vascular luminal surface by means of immunoconfocal microscopy was used to examine the spatial and temporal expression pattern of the endothelial connexins. Gap junction spots labeled by specific antisera against connexin37, connexin40, and connexin43 were quantified 7, 14, and 28 days after injury, and the relations among the connexins were examined by using colocalization analysis. Complementary electron microscopy was also conducted. After injury, the regenerating endothelium initially expressed small, sparse gap junctions, the numbers of which progressively increased to values equivalent to those of controls. Although connexin40 gap-junctional spot size and area returned to uninjured levels by 28 days after injury, connexin37 and connexin43 spot size and area exceeded those of the uninjured artery (P <0.05). Double-label analysis showed that even though colocalization of connexins to the same gap-junctional spot is a common feature, the extent of colocalization was time dependent (>80% in the intact artery at postinjury day 28 and <70% at postinjury days 7 and 14, P <0.01). We conclude that distinct alterations in expression of the 3 connexins are associated with regeneration of the arterial endothelium in situ, implying different intercellular communication requirements during the various phases of the healing process.
Our purpose was to depict the characteristics of the global vasculature of cervical lymphadenopathies and to clarify the efficiency of Doppler spectral analysis and power Doppler sonography in the ...differential diagnosis.
Prospectively, 289 lymph node lesions underwent Doppler flow studies and were grouped as metastasis, lymphoma, tuberculosis, and benign lymphadenopathies. Sonographic assessments included vascular pattern and vascular density (presented as vascularity index) as revealed by power Doppler sonography. Vascular resistive index and pulsatility index were assessed by at least three flow samplings. Values of both the highest and the lowest resistance were analyzed. Vascularity index, resistive index, pulsatility index, nodal size, and age were correlated.
Most benign lymphadenopathies (87%), tuberculous lymphadenopathies (72%), and lymphomas (71%) revealed an avascular or hilar vascular pattern. Vascular patterns of most metastatic lymphadenopathies (90%) were of spotted (26%), peripheral (11%), or mixed (53%) type. The vascularity indexes of metastatic lymphadenopathy (mean, 0.176) and lymphoma (mean, 0.122) were significantly higher than those of tuberculous and benign lymphadenopathy (mean, 0.054 and 0.042, respectively). In vascular resistance studies, the highest pulsatility index and resistive index in metastatic lymphadenopathy statistically exceeded those of benign lymphadenopathy, whereas no difference was found in the lowest values. Negative correlation was found between the vascularity index of metastatic lesions and their lowest vascular resistance, and positive correlation was found between vascularity index and nodal size in benign lymphadenopathies.
In addition to vascular resistance assessed traditionally with Doppler spectral analysis, vascular pattern and vascular density assessed with power Doppler sonography can better differentiate the nature of lymphadenopathies.
Carbon emissions from afforestation and tending operations were studied in this work. Renewable resources from the operations were evaluated in terms of their potential as fuel. New planting ...operations were found to result in higher energy consumption, biomass, and emissions compared with the tending operations. The greenhouse gas emissions from new planting and afforestation operations for plantation were 405.0 kg CO2/ha, 50.1 g CH4/ha, and 27.1 g N2O/ha, whereas those from the tending operations were 277.7 kg CO2/ha, 36.3 g CH4/ha, and 19.0 g N2O/ha. The major components of the renewable resources from the afforestation and tending operations were C, O, and H, and the contents of N and S were lower than those specified in the regulations by the European Union for refuse-derived fuels. Therefore, the refuse-derived fuel prepared from the renewable resources of the afforestation and tending operations did not cause NOx or SOx pollution. This fuel resulted in zero CO2 emissions, and it could be used as an alternative fuel for small boilers in the future.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Accurate assessment of the fetal organ volumes is very important in the evaluation of fetal well-being and maturation. Previous investigators have pointed out that fetal thigh volume (ThiV) may be a ...useful predictive factor of intrauterine growth retardation. Yet, 2-D ultrasound (US) is limited in assessing fetal ThiV accurately. With the recent advance of 3-D US, the limitation in assessing fetal ThiV by 2-D US can be overcome. To establish a normal reference chart of fetal ThiV for clinical use, a prospective and cross-sectional study using 3-D US was undertaken to assess the fetal ThiV in normal pregnancy. In total, 204 singleton fetuses ranging between 20 and 40 weeks of gestation and fitting the criteria of normal pregnancies were enrolled in this study. Our results showed that fetal ThiV is highly correlated with the gestational age (GA). Furthermore, using GA as the independent variable and ThiV as the dependent variable, the best-fit regression equation was ThiV (mL) = 35.494 − 4.985 × GA + 0.183 × GA
2 (r = 0.91,
n = 204,
p < 0.0001). For further clinical use, a chart of normal growth centiles of fetal ThiV was then calculated based on this equation. Furthermore, common indexes of fetal biometry, such as biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW), were all highly correlated with ThiV (all
p < 0.0001). In conclusion, our data of fetal ThiV assessed by 3-D US can serve as a useful reference in evaluating fetal growth and nutrition status during normal gestation.
We present an efficient vertical InGaN light-emitting diode (LED) in which the proposed vertical LEDs were fabricated with patterned sapphire substrates (PSS) using thinning techniques. After the ...thinning of sapphire substrate, selective dry etching process was performed on the remainder sapphire layer to expose the n-GaN contact layer instead of removing the sapphire substrate using the laser lift-off technique. These processes feature the LEDs with a sapphire-face-up structure and vertical conduction property. The PSS was adopted as a growth substrate to mitigate the light-guided effect, and thereby increase the light-extraction efficiency. Compared with conventional lateral GaN LEDs grown on PSS, the proposed vertical LEDs exhibit a higher light output power and less power degradation at a high driving current. This could be attributed to the fact that the vertical LEDs behave in a manner similar to flip-chip GaN/sapphire LEDs with excellent heat conduction.
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