Connectivity for species on the move Littlefield, Caitlin E; Krosby, Meade; Michalak, Julia L ...
Frontiers in ecology and the environment,
June 2019, Letnik:
17, Številka:
5
Journal Article
Recenzirano
Many species are already responding to global climate change by shifting their ranges to track suitable climatic conditions. However, habitat loss and fragmentation, coupled with the rapidity of ...climate change, make it difficult for species to keep pace. It is therefore unsurprising that enhancing landscape connectivity is the most frequently cited climate-adaptation strategy for conserving biodiversity. Yet most connectivity planning, even if intended to address climate change, does not directly take climate change and climate-driven range shifts into account. Nonetheless, several approaches that do explicitly address the unique challenges posed by climate change have recently emerged. We review these connectivity modeling approaches: specifically, how they incorporate species’ responses, identify movement routes, and address uncertainties. Despite this proliferation of approaches, conceptual and analytical hurdles remain, and meeting these challenges will be critical to achieving effective landscape connectivity for species in the face of climate change.
Most women diagnosed with endometrial cancer undergo primary surgical management with hysterectomy. Although racial disparities in readmission risk following hysterectomy for non-cancerous conditions ...have been reported, data among women with endometrial cancer are absent. This study evaluates racial differences in readmission risk among women undergoing endometrial cancer-related hysterectomy.
In the National Cancer Database, women who underwent surgical management for endometrial cancer from 2004 to 2018 were identified. Readmission and minimally invasive hysterectomy (MIH) proportions were plotted according to year of diagnosis and race/ethnicity. Multivariable logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between readmission risk and epidemiological, facility, tumor, and surgical characteristics. A base model was sequentially adjusted to incorporate significant covariates.
There were 350,631 patients included in the study. The proportion of MIH increased among all race/ethnicities over the study period; however, MIH rates were lower among Black women. Readmission proportions were 2.7% among White, 4.2% among Black, 2.9% among Hispanic, 2.4% among Asian, 2.1% among American Indian/Alaska Native, and 3.1% among Native Hawaiian/Pacific Islander women. In the fully adjusted model incorporating surgical approach, Black women (OR: 1.20, 95% CI = 1.13, 1.28) and Native Hawaiian/Pacific Islander women (OR: 1.54, 95% CI = 1.09, 2.18) were more commonly readmitted compared to White women.
In this study, Black and Native Hawaiian/Pacific Islander women with endometrial cancer had significantly higher readmission risk than White women. Optimizing perioperative care for minority women is an essential component of overcoming racially disparate endometrial cancer outcomes.
•Black and Native Hawaiian/Pacific Islander women are more likely than White women to be readmitted following hysterectomy.•Readmission rates consistently declined over the study period for White and Black women but varied among other groups.•Minimally invasive hysterectomy increased among women of all race/ethnicity groups during the study period.•In analyses stratified by procedure type, readmission was higher among Black as compared with White women.
•VTE is a rare, but potentially lethal postoperative complication in vulvar cancer patients undergoing surgical management.•Increased operating time, functional dependence, deep surgical site ...infection, and thrombocytosis increase risk for VTE.•Identifying these risks is important in determining which patients would benefit from postoperative VTE prophylaxis.
Due to low incidence of vulvar cancer (VC), incidence and predictors for development of venous thromboembolism (VTE) are poorly understood. We examined incidence and risk factors associated with VTE in patients undergoing surgery for VC.
We included patients who underwent surgery for VC from the National Surgical Quality Improvement Program database. VTE within the 30-day postoperative period was captured with Current Procedural Terminology codes. Baseline demographics and clinical characteristics were compared between patients with and without VTE. Univariable and multivariable-adjusted exact logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and VTE.
We identified 1414 patients undergoing procedures for VC from the NSQIP database. Overall, 11 (0.8 %) patients developed VTE. Univariable predictors of VTE included surgery type compared with simple vulvectomy: radical vulvectomy only (OR = 7.97, 95 % CI = 1.44, infinity) and radical vulvectomy plus unilateral IFN (OR = 15.98, 95 % CI = 2.70, infinity), unplanned readmission (OR = 11.56, 95 % CI = 2.74, 46.38), deep surgical site infection (OR = 16.05, 95 % CI = 1.59–85.50), and preoperative thrombocytosis (OR = 6.53, 95 % CI = 0.00, 34.86). In a multivariable-adjusted model, longer operative time (≥72 min OR = 11.33, 95 % CI = 1.58–499.03) and preoperative functional status compared with complete independence: total dependence (OR = 53.88, 95 % CI = 0.85, infinity) and partial dependence (OR = 53.88, 95 % CI = 0.85, infinity) were associated with VTE.
In this cohort of patients with VC undergoing radical vulvectomy, VTE incidence was low. Surgery type, longer operative time, dependent functional status, and wound disruption were identified as risk factors. Our findings highlight opportunities for prophylactic intervention in certain patients.
Racial and ethnic disparities in gynecologic cancer care have been documented. Treatment at academic facilities is associated with improved survival, yet no study has examined independent ...associations between race and ethnicity with facility type among gynecologic cancer patients.
We used the National Cancer Database and identified 484,455 gynecologic cancer (cervix, ovarian, uterine) patients diagnosed between 2004 and 2020. Facility type was dichotomized as academic vs. non-academic, and we used logistic regression to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between race and ethnicity and facility type. Secondarily, we examined joint effects of race and ethnicity and facility type on overall survival using Cox proportional hazards regression.
We observed higher odds of treatment at academic (vs. non-academic) facilities among American Indian/Alaska Native (OR = 1.42, 95% CI = 1.28–1.57), Asian (OR = 1.64, 95% CI = 1.59–1.70), Black (OR = 1.69, 95% CI = 1.65–1.72), Hispanic (OR = 1.70, 95% CI = 1.66–1.75), Native Hawaiian/Pacific Islander (OR = 1.74, 95% CI = 1.57–1.93), and other race (OR = 1.29, 95% CI = 1.20–1.40) patients compared with White patients. In the joint effects survival analysis with White, academic facility-treated patients as the reference group, Asian, Hispanic, and other race patients treated at academic or non-academic facilities had improved overall survival. Conversely, Black patients treated at academic facilities Hazard Ratio (HR) = 1.10, 95% CI = 1.07–1.12 or non-academic facilities (HR = 1.19, 95% CI = 1.16–1.21) had worse survival.
Minoritized gynecologic cancer patients were more likely than White patients to receive treatment at academic facilities. Importantly, survival outcomes among patients receiving care at academic institutions differed by race, requiring research to investigate intra-facility survival disparities.
•Minoritized gynecologic cancer patients were more likely than White patients to receive treatment at an academic facility.•Compared with White, academic facility-treated patients, Asian and Hispanic patients had improved overall survival.•Black patients had worse survival, regardless of treatment facility, when compared with White, academic facility-treated patients.
To determine whether frailty is associated with post-operative complications following surgery for vulvar cancer.
This retrospective study used a multi-institutional dataset from the National ...Surgical Quality Improvement Program (NSQIP) database (2014-2020) to analyze the relationship between frailty, procedure type, and post-operative complications. Frailty was determined using the modified frailty index-5 (mFI-5). Univariate and multivariable-adjusted logistic regression analyses were performed.
Of 886 women, 49.9% underwent radical vulvectomy alone, and 19.5% and 30.6% underwent concurrent unilateral or bilateral inguinofemoral lymphadenectomy, respectively; 24.5% had mFI ≥2 and were considered frail. Compared with non-frail women, those with an mFI ≥2 were more likely to have an unplanned readmission (12.9% vs 7.8%, p=0.02), wound disruption (8.3% vs 4.2%, p=0.02), and deep surgical site infection (3.7% vs 1.4%, p=0.04). On multivariable-adjusted models, frailty was a significant predictor for minor (OR 1.58, 95% CI 1.09 to 2.30) and any complications (OR 1.46, 95% CI 1.02 to 2.08). Specifically, for radical vulvectomy with bilateral inguinofemoral lymphadenectomy, frailty was significantly associated with major (OR 2.13, 95% CI 1.03 to 4.40) and any complications (OR 2.10, 95% CI 1.14 to 3.87).
In this analysis of the NSQIP database, nearly 25% of women undergoing radical vulvectomy were considered frail. Frailty was associated with increased post-operative complications, especially in women concurrently undergoing bilateral inguinofemoral lymphadenectomy. Frailty screening prior to radical vulvectomy may assist in patient counseling and improve post-operative outcomes.
Racial and ethnic disparities in clinical trial enrollment are unjust and hinder development of new cancer treatments.
To examine the association of race and ethnicity with clinical trial enrollment ...among women with endometrial, ovarian, or cervical cancer.
This retrospective cohort study used data from the National Cancer Database, a hospital-based cancer registry, and the Surveillance, Epidemiology, and End Results Program (SEER), a population-based cancer registry. Population-based race and ethnicity-specific proportions for each cancer site were derived from SEER. Participants included women with an endometrial, ovarian, or cervical cancer diagnosed from 2004 to 2019. Analyses were performed from February 2 to June 14, 2023.
Race and ethnicity were categorized as American Indian/Alaska Native, Asian, Black, Hispanic (any race), Native Hawaiian/Pacific Islander, White, and other (not defined in the National Cancer Database).
The primary outcomes were the odds of clinical trial enrollment and representation in clinical trials compared with the US population. Multivariable-adjusted logistic regression was used to estimate odds ratios (ORs) and 95% CIs for associations of race and ethnicity with clinical trial enrollment within the National Cancer Database sample. Participation-to-prevalence ratios (PPRs) according to diagnosis period (2004-2011 vs 2012-2019) were calculated by dividing the race and ethnicity-specific percentage of clinical trial participants in the study sample by the percentage of racial and ethnic groups in SEER.
Among 562 592 patients with gynecologic cancer (mean SD age at diagnosis, 62.9 11.3 years), 1903 were American Indian/Alaska Native, 18 680 were Asian, 56 421 were Black, 38 145 were Hispanic, 1453 were Native Hawaiian/Pacific Islander, 442 869 were White, and 3121 were other race and ethnicity. Only 548 (<1%) were enrolled in clinical trials. Compared with White women, clinical trial enrollment was lower for Asian (OR, 0.44; 95% CI, 0.25-0.78), Black (OR, 0.70; 95% CI, 0.50-0.99), and Hispanic (OR, 0.53; 95% CI, 0.33-0.83) women. Compared with the US population, White women were adequately or overrepresented for all cancer types (PPRs ≥1.1), Black women were adequately or overrepresented for endometrial and cervical cancers (PPRs ≥1.1) but underrepresented for ovarian cancer (PPR ≤0.6), and Asian and Hispanic women were underrepresented among all 3 cancer types (PPRs ≤0.6).
In this cohort of patients with gynecologic cancer, clinical trial enrollment was lower among certain minoritized racial and ethnic groups. Continued efforts are needed to address disparate clinical trial enrollment among underrepresented groups.
To describe stage, treatment patterns, and survival for glassy cell carcinoma of the cervix (GCCC), a poorly understood rare tumor.
Clinical data and survival were compared between GCCC and more ...common histologic types using the National Cancer Database (NCDB) from 2004 to 2017. A retrospective review of GCCC cases at our institution from 2012 to 2020 was simultaneously performed with staging updated according to 2018 FIGO staging. Descriptive statistics and survival analyses were performed, and outcomes compared to historical references.
143/89,001 (0.16%) NCDB cervical cancer cases were GCCC. Compared to other histologies, GCCC cases were younger, with 74.8% diagnosed before age 50. Stage distribution was similar. Stage I cases were less commonly treated with surgery alone (19/69, 27%). 79.4% of locally advanced (stage II-IVA) cases were treated with definitive chemoradiation. GCCC demonstrated worse OS for early-stage and locally-advanced disease. No survival differences were observed for patients with stage IVB disease.
Our institutional review identified 14 GCCC cases. Median age at diagnosis was 34 years. All nine early-stage cases underwent radical hysterectomy. Adjuvant radiation was given for cases meeting Sedlis criteria (4/9, 44%). All five advanced stage cases were stage IIIC and received definitive chemoradiation. Recurrence rate was 0% (0/9) for early-stage and 60% (3/5) for advanced-stage cases. 3-year PFS was 100% for early-stage and 40% for advanced-stage. 3-year OS was 100% for early-stage and 60% for advanced-stage GCCC.
GCCC presents at earlier ages than other cervical cancer histologic types. Although NCDB showed worse OS, our more contemporary institutional review, which incorporates updated staging and newer treatment modalities found outcomes more similar to historical references of more common histologic subtypes.
•A National Cancer Database (NCDB) analysis shows worse outcomes for glassy cell carcinoma of the cervix across all stages.•When cases are staged by 2018 FIGO staging, outcomes are not worse for early-stage GCCC in the institutional series.
We examined associations between patient and treatment characteristics with longitudinally collected patient-reported outcome (PRO) measures to provide a data-informed description of the experiences ...of women undergoing treatment for endometrial cancer.
We administered National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires at the preoperative visit and at 6 and 12 months after surgery. Anxiety, depression, fatigue, sleep disturbance, pain, physical function, and ability to participate in social roles were assessed. Analysis of variance (ANOVA) and linear mixed models were used to examine associations between patient characteristics and PRO measures at baseline and through time.
Of 187 women enrolled, 174 (93%) and 103 (69%) completed the 6- and 12-month questionnaires, respectively. Anxiety was substantially elevated at baseline (half of one population-level standard deviation) and returned to general population mean levels at 6 and 12 months. Younger age, Medicaid/None/Self-pay insurance, prevalent diabetes, and current smoking were associated with higher symptom burden on multiple PRO measures across the three time points. Women with aggressive histology, higher disease stage, or those with adjuvant treatment had worse fatigue at 6 months, which normalized by 12 months.
We observed a high symptom burden at endometrial cancer diagnosis, with most PRO measures returning to general population means by 1 year. Information on risk factor-PRO associations can be used during the clinical visit to inform supportive service referral.
These findings can inform clinicians' discussions with endometrial cancer survivors regarding expected symptom trajectory following diagnosis and treatment.
Background
Web-based surveys provide an efficient means to track clinical outcomes over time
without the use of clinician time for additional paperwork. Our purpose was to determine
the feasibility ...of utilizing web-based surveys to capture rehabilitation compliance and
clinical outcomes among postoperative orthopedic patients. The study hypotheses were
that (a) recruitment rate would be high (>90%), (b) patients receiving surveys every
two weeks would demonstrate higher response rates than patients that receive surveys
every four weeks, and (c) response rates would decrease over time.
Methods
The study deaign involved a longitudinal cohort. Surgical knee patients were recruited
for study participation during their first post-operative visit
(n = 59, 34.9 ± 12.0 years of age). Patients with Internet access, an
available email address and willingness to participate were counter-balanced into groups
to receive surveys either every two or four weeks for 24 weeks post-surgery. The surveys
included questions related to rehabilitation and questions from standard
patient-reported outcome measures. Outcome measures included recruitment
rate (participants consented/patients approached),
eligibility (participants with email/participants consented),
willingness (willing participants/participants eligible), and
response rate (percentage of surveys completed by willing
participants).
Results
Fifty-nine patients were approached regarding participation. Recruitment rate was 98%
(n = 58). Eligibility was 95% (n = 55), and
willingness was 91% (n = 50). The average response rate was 42% across
both groups. There was no difference in the median response rates between the two-week
(50%, range 0–100%) and four-week groups (33%, range 0–100%;
p = 0.55).
Conclusions
Although patients report being willing and able to participate in a web-based survey,
response rates failed to exceed 50% in both the two-week and four-week groups.
Furthermore, response rates began to decrease after the first three months
postoperatively. Therefore, supplementary data collection procedures may be necessary to
meet established research quality standards.
Background Web-based surveys provide an efficient means to track clinical outcomes over timewithout the use of clinician time for additional paperwork. Our purpose was to determinethe feasibility of ...utilizing web-based surveys to capture rehabilitation compliance andclinical outcomes among postoperative orthopedic patients. The study hypotheses werethat (a) recruitment rate would be high (>90%), (b) patients receiving surveys everytwo weeks would demonstrate higher response rates than patients that receive surveysevery four weeks, and (c) response rates would decrease over time. Methods The study deaign involved a longitudinal cohort. Surgical knee patients were recruitedfor study participation during their first post-operative visit(n = 59, 34.9 ± 12.0 years of age). Patients with Internet access, anavailable email address and willingness to participate were counter-balanced into groupsto receive surveys either every two or four weeks for 24 weeks post-surgery. The surveysincluded questions related to rehabilitation and questions from standardpatient-reported outcome measures. Outcome measures included recruitmentrate (participants consented/patients approached),eligibility (participants with email/participants consented),willingness (willing participants/participants eligible), andresponse rate (percentage of surveys completed by willingparticipants). Results Fifty-nine patients were approached regarding participation. Recruitment rate was 98%(n = 58). Eligibility was 95% (n = 55), andwillingness was 91% (n = 50). The average response rate was 42% acrossboth groups. There was no difference in the median response rates between the two-week(50%, range 0–100%) and four-week groups (33%, range 0–100%;p = 0.55). Conclusions Although patients report being willing and able to participate in a web-based survey,response rates failed to exceed 50% in both the two-week and four-week groups.Furthermore, response rates began to decrease after the first three monthspostoperatively. Therefore, supplementary data collection procedures may be necessary tomeet established research quality standards.
PDF