Supermarkets might influence food choices, and more distal outcomes like obesity, by increasing the availability of healthy foods. However, recent evidence about their effects is ambiguous, perhaps ...because supermarkets also increase the availability of unhealthy options. We develop an alternative measure of food environment quality that characterizes urban neighborhoods by the relative amounts of healthy (e.g. fruits and vegetables) to unhealthy foods (e.g. energy-dense snacks). Using data from 307 food stores and 1243 telephone interviews with residents in urban southeastern Louisiana, we estimate a multilevel multinomial logistic model for overweight status. We find that higher quality food environments – but not food store types – decrease the risk of obesity (RR 0.474, 95% CI 0.269–0.835) and overweight (RR 0.532, 95% CI 0.312–0.907). The findings suggest a need to move beyond a sole consideration of food store types to a more nuanced view of the food environment when planning for change.
► We model food environment predictors of obesity in southeastern Louisiana. ► We use an alternative measure based on in-store contents and GIS mapping of stores. ► The measure is a proxy for relative availability of healthy to unhealthy food. ► Healthier food environments, but not food store types, decrease the risk of obesity.
•Largest experience to date of the results of follow-up testing stage III NSCLC.•No survival difference between relapse detected by symptoms vs. routine CT chest.•Favorable outcomes seen in ...symptomatic patients with only CNS relapse.•The CNS results obscured potential benefits from chest CT.•Routine CNS and chest imaging may improve outcomes.
The majority of patients with locally advanced non-small cell lung cancer (LANSCLC) will recur after receiving multimodal treatment with curative intent. Current guidelines recommend routine follow-up with computerized tomography (CT) scans, though minimal data exist on the utility of this approach nor has an optimal follow-up strategy to detect recurrence been defined. This study examined whether survival varied if relapse was detected with scheduled follow-up CT versus symptoms, and whether the pattern of recurrence affected these outcomes.
Single institution retrospective review of patients who had undergone definitive management of LANSCLC with chemoradiotherapy +/- surgical resection. Standard follow-up testing consisted of routine exam and chest CT beginning at every 3 months in the first year and decreasing to annually after the fifth year.
311 patients were assessed, of which 167 patients recurred and were evaluable. 104 progressions were detected by follow-up and 63 by symptoms. For the entire group, there was no difference in overall survival (OS) for those detected by scans vs. symptoms (7.6 vs. 6.1 months, p = 0.797). After excluding patients with oligometastatic (1–3) brain metastases (OBM), OS was superior in patients with scan detected relapse (7.5 vs. 3.4 months, p = 0.013).
Routine surveillance by CT chest detects more localized disease than symptom driven follow-up, though OS does not differ. This null result is largely driven by the favorable outcomes for patients with OBM who present symptomatically. A strategy of both chest and brain imaging could be considered and warrants further investigation.
Dietary patterns may be influenced by the availability and accessibility within stores of different types of foods. However, little is known about the amount of shelf space used for healthy and ...unhealthy foods in different types of stores. We conducted measurements of the length of shelf space used for fruits, vegetables, and snack foods items in 419 stores in 217 urban census tracts in southern Louisiana and in Los Angeles County. Although supermarkets offered far more shelf space of fruits and vegetables than did other types of stores, they also devoted more shelf space to unhealthy snacks (mean 205 m for all of these items combined) than to fruits and vegetables (mean 117 m,
p
< 0.001). After supermarkets, drug stores devoted the most shelf space to unhealthy items. The ratio of the total shelf space for fruits and vegetables to the total shelf space for these unhealthy snack items was the lowest (0.10 or below) and very similar in convenience stores, drug stores, and liquor stores, was in a middle range (0.18 to 0.30) in small food stores, and was highest in medium-sized food stores (0.40 to 0.61) and supermarkets (0.55 to 0.72). Simple measurements of shelf space can be used by researchers to characterize the healthfulness of the food environment and by policymakers to establish criteria for favorable policy treatment of stores.
Abstract Objective Nearly all research on the food environment and diet has not accounted for car ownership — a potential key modifying factor. This study examined the modifying effect of car ...ownership on the relationship between neighborhood fruit and vegetable availability and intake. Methods Data on respondents' (n = 760) fruit and vegetable intake, car ownership, and demographics came from the 2008 New Orleans Behavioral Risk Factor Surveillance System. Shelf space data on fresh, frozen, and canned fruits and vegetables were collected in 2008 from a random sample of New Orleans stores (n = 114). Availability measures were constructed by summing the amount of fruit and vegetable shelf space in all stores within defined distances from respondent households. Regression analyses controlled for demographics and were run separately for respondents with and without a car. Results Fruit and vegetable availability was positively associated with intake among non-car owners. An additional 100 m of shelf space within 2 km of a residence was predictive of a half-serving/day increase in fruit and vegetable intake. Availability was not associated with intake among car owners. Conclusions Future research and interventions to increase neighborhood healthy food options should consider car ownership rates in their target areas as an important modifying factor.
Most public health studies on the neighborhood food environment have focused on types of stores and their geographic placement, yet marketing research has long documented the influence of in-store ...shelf-space on consumer behavior.
This paper combines these two strands of research to test whether the aggregate availability of specific foods in a neighborhood is associated with the BMIs of its residents.
Fielded from October 2004 to August 2005, this study combines mapping of retail food outlets, in-store surveys, and telephone interviews of residents from 103 randomly sampled urban census tracts in southeastern Louisiana. Linear shelf-space of fruits, vegetables, and energy-dense snack foods was measured in 307 food stores in the study tracts. Residential addresses, demographic information, and heights and weights were obtained from 1243 respondents through telephone interviews. Cumulative shelf-space of foods within defined distances of each respondent was calculated using observations from the in-store survey and probability-based assignments of shelf-space to all unobserved stores in the area.
After controlling for sociodemographic variables, income, and car ownership, regression analysis, conducted in 2008, showed that cumulative shelf-space availability of energy-dense snack foods was positively, although modestly, associated with BMI. A 100-meter increase in shelf-space of these foods within 1 kilometer of a respondent's household was associated with an additional 0.1 BMI points. Fruit and vegetable shelf-space was not significantly related to BMI.
Interventions that seek to improve the neighborhood food environment may need to focus on more than just increasing access to healthy foods, because the results suggest that the availability of energy-dense snack foods plays a role in weight status.
•EGFR-mutant tumors with exon 19 deletions, L858R mutations, or exon 20 insertions were less likely to be PD-L1 high (TPS ≥ 50%) or TMB high (≥10 mut/MB) as compared to wild-type (WT) tumors. Among ...EGFR-mutant tumors, those with uncommon alterations in L861Q and G719X had greater rates of TMB high and TP53 co-mutations.•Utilizing bulk RNA sequencing data to characterize the immune tumor microenvironment (TME), exon 19 deletion and L858R mutation tumors were found to have lower median percent fractions of CD8+ T cells versus WT. However, a wide range of values for CD8+ T cells was observed and a subset of exon 19 deletion and L858R tumors had higher values comparable to WT.•Exon 19 deletion, L858R, and exon 20 insertion tumors were enriched with immunosuppressive M2 macrophages and neutrophils as compared to WT. In contrast, L861Q and G719X tumors had levels of M2 macrophages similar to WT.•A small subset of EGFR-mutant tumors, particularly those with uncommon alterations, bear characteristics that may render them more immunogenic. Continued research is needed to evaluate biomarkers, including the specific subtype of EGFR, as predictors of immunotherapy response to better identify the small subgroup of patients with EGFR-mutant disease that benefit from checkpoint inhibitors.
Cancer/testis antigens (CTAs) are strongly expressed in some solid tumors but minimally expressed in normal tissue, making them appealing therapeutic targets. KK-LC-1 (CXorf61) has cytoplasmic ...expression in gastric, breast, and lung cancer. We characterized the molecular subtypes of non-small cell lung cancer (NSCLC) expressing KK-LC-1 to inform rational clinical trials of T-cell receptor therapy (TCR-T) targeting KK-LC-1. 9790 NSCLC tumors that underwent whole transcriptome sequencing (Illumina NovaSeq) and NextGen DNA sequencing (NextSeq, 592 Genes and NovaSEQ, WES) at Caris Life Sciences (Phoenix, AZ) were analyzed. Tumors were split into quartiles based on KK-LC-1 expression and pathological and molecular differences were investigated. Adenocarcinoma had significantly higher KK-LC-1 expression than squamous cell carcinoma (median, 3.25 vs. 1.17 transcripts per million (TPM),
< 0.0001). Tumors with the highest quartile of KK-LC-1 expression had a greater proportion of tumors with high tumor mutation burden (TMB) (≥10 mutations per megabase; 44% vs. 28% in Q1,
< 0.001). Increased KK-LC-1 expression was associated with increased M1 macrophage abundance. Higher levels of KK-LC-1 expression were seen in pan-wild type and
mutated tumors and associated with high TMB. TCR-T therapy directed against KK-LC-1 should be considered in patients whose clinical features reflect these characteristics.
Abstract Objective Recent work demonstrates the importance of in-store contents, yet most food access disparity research has focused on differences in store access, rather than the foods they carry. ...This study examined in-store shelf space of key foods to test whether other types of stores might offset the relative lack of supermarkets in African-American neighborhoods. Methods New Orleans census tract data were combined with health department information on food stores open in 2004–2005. Shelf space of fruits, vegetables, and energy-dense snacks was assessed using a measuring wheel and established protocols in a sample of stores. Neighborhood availability of foods was calculated by summing shelf space in all stores within 2 km of tract centers. Regression analyses assessed associations between tract racial composition and aggregate food availability. Results African-American neighborhoods had fewer supermarkets and the aggregate availability of fresh fruits and vegetables was lower than in other neighborhoods. There were no differences in snack food availability. Conclusions Other store types did not offset the relative lack of supermarkets in African-American neighborhoods in the provision of fresh produce, though they did for snack foods. Altering the mix of foods offered in such stores might mitigate these inequities.
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