Tensile modulus of polymer halloysite nanotubes nanocomposites assuming stress transferring through an imperfect interphase.

In this work, Hui-Shia model is developed to reveal the efficiency of a deficient interphase on the tensile modulus of polymer halloysite nanotube (HNT) nanocomposites. "Lc" as essential HNT length providing full stress transferring is defined and effective HNT size, effective HNT concentration, and efficiency of stress transferring (Q) are expressed by "Lc". Furthermore, the influences of all terms on the "Q" and nanocomposite's modulus are clarified, and also the calculations of the model are linked to the tested data of some nanocomposites. Original Hui-Shia model overpredicts the moduli, but the innovative model's predictions appropriately fit the measured data. Lc = 200 nm maximizes the sample's modulus to 2.6 GPa, but the modulus reduces to 2.11 GPa at Lc = 700 nm. Therefore, there is a reverse relation between the sample's modulus and "Lc". Q = 0.5 produces the system's modulus of 2.1 GPa, while the modulus of 2.35 GPa is achieved at Q = 1 providing a direct relation between the nanocomposite's modulus and "Q". Generally, narrow and big HNTs, along with a low "Lc", enhance the "Q", because a lower "Lc", reveals a tougher interphase improving the stress transferring.

Multifaceted natural drought response mechanisms in three elite date palm cultivars uncovered by expressed sequence tags analysis.

This study extends our prior research on drought responses in three date palm cultivars (Khalas, Reziz, and Sheshi) under controlled conditions. Here, we investigated their drought stress adaptive strategies under ambient environment. Under natural field drought conditions, three date palm cultivars experienced significantly (p ≤ 0.05) varying regulations in their physiological attributes. Specifically, chlorophyll content, leaf RWC, photosynthesis, stomatal conductance, and transpiration reduced significantly, while intercellular CO2 concentration and water use efficiency increased. Through suppression subtraction hybridization (SSH), a rich repertoire (1026) of drought-responsive expressed sequence tags (ESTs) were identified: 300 in Khalas, 343 in Reziz, and 383 in Sheshi. Functional analysis of ESTs, including gene annotation and KEGG pathways elucidation, unveiled that these cultivars withstand drought by leveraging indigenous and multifaceted pathways. While some pathways aligned with previously reported drought resilience mechanism observed under controlled conditions, several new indigenous pathways were noted, pinpointing cultivar-specific adaptations. ESTs identified in three date palm cultivars were enriched through GSEA analysis. Khalas exhibited enrichment in cellular and metabolic processes, catalytic activity, and metal ion binding. Reziz showed enrichment in biological regulation, metabolic processes, signaling, and nuclear functions. Conversely, Sheshi displayed enrichment in organelle, photosynthetic, and ribosomal components. Notably, ca. 50% of the ESTs were unique and novel, underlining the complexity of their adaptive genetic toolkit. Overall, Khalas displayed superior drought tolerance, followed by Reziz and Sheshi, highlighting cultivar-specific variability in adaptation. Conclusively, date palm cultivars exhibited diverse genetic and physiological strategies to cope with drought, demonstrating greater complexity in their resilience compared to controlled settings.

Impact of GLP-1RA on the Risk of Adverse Liver Outcomes Among Patients With Alcohol-Associated Liver Disease and Type 2 Diabetes.

BACKGROUND AND AIMS: We sought to characterise the impact of GLP-1RA on adverse liver outcomes (ALO) among patients with alcohol-associated liver disease (ALD) and Type 2 diabetes mellitus (T2DM). METHODS: Patients with T2DM newly diagnosed with ALD between 2013 and 2020 were identified using IBM MarketScan database and were categorised by GLP-1RA exposure. Overlap propensity score weighting (OPSW) followed by Poisson regression models was used to analyse adjusted risk of ALO, a composite endpoint defined by first occurrence of hepatic decompensation (HD), portal hypertension (PH), hepatocellular carcinoma (HCC) or liver transplantation (LT) relative to GLP-1RA. RESULTS: Among 14 730 patients, most individuals were male (n = 9752, 66.2%) with median age of 57 (IQR 52-61) years; 2.2% (n = 317) of patients had GLP-1RA exposure. Overall, 32.0% (n = 4717) of patients experienced HD, 15.9% (n = 2345) had PH, 3.8% (n = 563) developed HCC, while 2.5% (n = 374) underwent transplantation. Non-GLP-1RA patients had higher incidence of HD (32.2% vs. 22.4%) and HCC (3.9% vs. 0.3%) versus patients taking GLP-1RA (both p < 0.001); in contrast, there was no difference in incidence of PH (14.5% vs. 16.0%) and LT (1.3% vs. 2.6%) (both p > 0.05). After OPSW, overall incidence of ALO was lower in GLP-1RA cohort (GLP-1RA: 12.0%, 95%CI 9.0-16.0 vs. non-GLP-1RA: 21.0%, 95%CI 20.0-22.0) with an absolute incidence risk reduction of 9.0% (95%CI 3.0%-15.0%) associated with GLP-1RA. GLP-1RA was most strongly associated with lower likelihood of HD with reduced adjusted incidence rate of 0.56 (95%CI 0.36-0.86) relative to non-GLP-1RA individuals. CONCLUSIONS: GLP-1RA may have a hepatoprotective impact among patients with ALD and T2DM.

Variation in Physician Spending and its Association with Postoperative Outcomes among Patients undergoing Surgery for Gastrointestinal Cancer.

BACKGROUND: There is significant variation in inpatient expenditures among physicians and hospitals. We sought to characterize the association of variation in physician spending with short-term outcomes among patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC) and colorectal cancer (CRC). METHODS: Patients who underwent surgery for PDAC and CRC from 2010-2020 were identified using the Surveillance, Epidemiology, and End Result (SEER)-Medicare-linked database. The cohort was divided into quartiles based on adjusted physician spending and multivariable models were utilized to assess the association of physician spending with patient outcomes. RESULTS: Among 27,596 Medicare beneficiaries, around 92.8% (n=25,615) and 7.2% (n=1,981) underwent surgery for CRC and PDAC, respectively. Around 79.9% of the variation in spending was due to patient-level factors, 13.3% was due to hospital characteristics, and 6.8% was due to surgeon-level variables. On multivariable analysis, there was no significant association between physician spending and 30-day readmission (With complications: Q1 referent; Q4 OR 1.10 95%CI 0.86-1.41 [p=0.123], Without complications: Q1 referent; Q3 Stage IV OR 0.97 95%CI 0.68-1.40 [p=0.882]) and 30-day mortality (Without Complications: Q1 referent; Q2 Stage I OR1.17 95% CI 0.45-3.01 [p=0.804]). However, an increase in physician spending was associated with higher 30-day mortality among patients with complications (Q1 referent; Q4 OR 2.28 95%CI 1.72-3.03[p<0.001]). CONCLUSION: There is more variation in healthcare spending across hospitals than across individual physicians. Our results demonstrated no consistent association between variation in physician spending and patient outcomes. Wasteful spending can be reduced through targeted interventions aimed at reducing variations at the physician and hospital levels.

Longitudinal-Torsional Frequency Coupling Design of Novel Ultrasonic Horns for Giant Magnetostrictive Transducers.

The use of advanced brittle composites in engineering systems has necessitated robotic rotary ultrasonic machining to attain high precision with minimal machining defects such as delamination, burrs, and cracks. Longitudinal-torsional coupled (LTC) vibrations are created by introducing helical slots to a horn's profile to enhance the quality of ultrasonic machining. In this investigative research, modified ultrasonic horns were designed for a giant magnetostrictive transducer by generating helical slots in catenoidal and cubic polynomial profiles to attain a high amplitude ratio (TA/LA) and low stress concentrations. Novel ultrasonic horns with a giant magnetostrictive transducer were modelled to compute impedances and harmonic excitation responses. A structural dynamic analysis was conducted to investigate the effect of the location, width, depth and angle of helical slots on the Eigenfrequencies, torsional vibration amplitude, longitudinal vibration amplitude, stresses and amplitude ratio in novel LTC ultrasonic horns for different materials using the finite element method (FEM) based on the block Lanczos and full-solution methods. The newly designed horns achieved a higher amplitude ratio and lower stresses in comparison to the Bezier and industrial stepped LTC horns with the same length, end diameters and operating conditions. The novel cubic polynomial LTC ultrasonic horn was found superior to its catenoidal counterpart as a result of an 8.45% higher amplitude ratio. However, the catenoidal LTC ultrasonic horn exhibited 1.87% lower stress levels. The position of the helical slots was found to have the most significant influence on the vibration characteristics of LTC ultrasonic horns followed by the width, depth and angle. This high amplitude ratio will contribute to the improved vibration characteristics that will help realize good surface morphology when machining advanced materials.

Clinical Outcomes, Costs, and Value of Surgery Among Older Patients with Colon Cancer at US News and World Report Ranked Versus Unranked Hospitals.

BACKGROUND: US News and World Report (USNWR) hospital rankings influence patient choice of hospital, but their association with surgical outcomes remains ill-defined. We sought to characterize clinical outcomes and costs of surgery for colon cancer among USNWR top ranked and unranked hospitals. METHODS: Using Medicare Standard Analytic Files, patients aged ≥65 years undergoing surgery for colon cancer were identified. Hospitals were categorized as 'ranked' or 'unranked' based on USNWR cancer hospital rankings. One-to-one matching was performed between patients treated at ranked and unranked hospitals, and clinical outcomes and costs of surgery were compared. RESULTS: Among 50 ranked and 2522 unranked hospitals, 13,650 patient pairs were compared. Overall, 30-day mortality was 2.13% in ranked hospitals versus 3.68% in unranked hospitals (p < 0.0001), and the overall paired cost difference was $8159 (p < 0.0001). As patient risk increased, 30-day mortality differences became larger, with the ranked hospitals having 30-day mortality of 7.59% versus 11.84% for unranked hospitals among the highest-risk patients (p < 0.0001). Overall paired cost differences also increased with increasing patient risk, with cost of care being $72,229 for ranked hospitals versus $56,512 for unranked hospitals among the highest-risk patients (difference = $14,394; p = 0.02). The difference in cost per 1% reduction in 30-day mortality was $9009 (95% confidence interval [CI] $6422-$11,597) for lowest-risk patients, which dropped to $3387 (95% CI $2656-$4119) for highest-risk patients (p < 0.0001). CONCLUSION: Treatment at USNWR-ranked hospitals, particularly for higher-risk patients, was associated with better outcomes but higher-cost care. The benefit of being treated at highly ranked USNWR hospitals was most pronounced among high-risk patients.

A novel approach to predict the electrical conductivity of nanocomposites by a weak interphase around graphene network.

Herein, we offer a model for estimating the tunneling conductivity of polymer-graphene nanocomposites based on interfacial properties, the proportion of networked graphene, and the wettability value between the polymer medium and the filler. The interfacial properties are influenced by the minimum diameter of the nanosheets (Dc), whose conductivity can be transferred to the medium via interfacial conduction (τ). These parameters impact the actual aspect ratio and the volume proportion of the filler, which, in turn, control the onset of percolation and the proportion of nanosheets in the network. We apply all these parameters to develop a novel model for estimating the conductivity of graphene systems. The predictions obtained from this model across different parameter ranges are discussed. Additionally, experimental measurements are employed to evaluate the proposed equations. High filler conductivity enhances the nanocomposite's conductivity by a strong interfacial conduction. However, the conductivity cannot be transferred to the polymer medium under condition of weak interfacial conduction. Furthermore, a robust interphase and a small Dc contribute to increased conductivity. Ultimately, the developed equations accurately predict the onset of percolation and conductivity, validated by real experimental data.

Diuretic and Anti-hyperuricemic Effects of Geranyl Acetate in Rats.

BACKGROUND: Geranyl acetate, a compound found in plant oils, has been studied for its potential effects on renal and cardiovascular ailments. OBJECTIVE: This study aimed to investigate the diuretic and anti-hyperuricemic properties of geranyl acetate in male Wistar rats using a hyperuricemia-induced rat model. METHODS: Molecular docking studies were conducted to assess geranyl acetate's interactions with various targets. in vitro studies were performed to evaluate its scavenging ability and inhibition of xanthine oxidase, urease, and acetylcholinesterase. Subsequently, we administered different doses of geranyl acetate (25, 50, and 100 mg/kg) and a reference drug (furosemide) to the rats to assess their acute and repeated dose diuretic effects over seven days. To understand the diuretic mechanism, we used inhibitors, such as L-- NAME, indomethacin, and atropine, prior to administering geranyl acetate. We also tested the anti-hyperuricemic potential of geranyl acetate on hyperuricemic rats. RESULTS: Molecular docking suggested strong binding between geranyl acetate and nitric oxide synthase. in vitro studies showed significant free radical scavenging activity and and inhibition of acetylcholinesterase, xanthine oxidase, and urease. The 100 mg/kg dose exhibited the most promising diuretic effects, with nitric oxide appearing to influence its action. Uric acid excretion increased at this dose, resembling allopurinol effects. CONCLUSION: Geranyl acetate has demonstrated significant diuretic and anti-hyperuricemic effects, likely influenced by nitric oxide release and inhibition of enzymes, like xanthine oxidase and urease. The findings have suggested potential benefits for individuals with kidney ailments, hypertension, and gout.

A novel technique including two steps for modulus prediction in polymer halloysite nanotube composites.

A two-step methodology has been developed utilizing the models of Paul and Takayanagi to determine the modulus of polymer halloysite nanotube (HNT) products. Initially, HNTs and the adjacent interphase are considered as pseudoparticles, and their modulus is evaluated using the Paul model. Subsequently, the modulus of a nanocomposite, consisting of a polymer medium and pseudoparticles, is predicted by Takayanagi equation. The impacts of various factors on the modulus of the products are analyzed, and the results from the two-step method are compared with experimental data from different samples. It has been observed that the modulus of samples progressively increases with an increase in interphase depth. Also, a higher interphase modulus contributes to an enhanced modulus of samples. Nevertheless, excessively high interphase moduli (Ei > 60 GPa) result in only a marginal improvement in the modulus of nanocomposites. Additionally, narrower HNTs are advantageous for producing stronger samples, though the modulus of the nanocomposites slightly diminishes at very high HNT radii (R > 55 nm). The outputs of two-step method agree with the experimental moduli of various HNT-filled systems.

Outcomes of liver transplant for colorectal liver metastasis: a systematic review and meta-analysis.

BACKGROUND: Liver transplantation (LT) for nonresectable colorectal liver metastasis (NRCRLM) has become accepted for select patients meeting strict inclusion criteria. Advancements in patient selection and understanding of cancer biology may expand benefits to patients with colorectal liver metastasis (CRLM). In this meta-analysis, we sought to assess survival outcomes, recurrence patterns, and quality of life (QoL) after LT for CRLM. METHODS: PubMed, Embase, and Scopus databases were searched. A random-effect meta-analysis was conducted to obtain pooled overall survival (OS) and disease-free survival (DFS) rates and to compare QoL from baseline. Continuous data were analyzed, and standardized mean differences were reported. RESULTS: Overall, 16 studies (403 patients, 58.8% male sex) were included. The pooled 1-, 3-, and 5-year OS after LT for NRCRLM was 96% (95% CI: 92%-99%), 77% (95% CI: 62%-89%), and 53% (95% CI: 45%-61%), respectively. Moreover, the pooled 1-, 3-, and 5-year DFS was 58% (95% CI: 43%-72%), 33% (95% CI: 9%-61%), and 13% (95% CI: 4%-27%), respectively. Overall, 201 patients (49.8%) experienced recurrence during the follow-up period with the lungs being the most common site (45.8%). There was no significant differences in physical and emotional functioning, fatigue, and pain components of QoL at 6 months after LT compared with baseline (all P > .05). CONCLUSION: LT for NRCRLM demonstrated good OS outcomes with no differences in the QoL at 6 months after transplantation. Transplantation may represent a viable treatment option for NRCRLM.

Fabrication of a graphene@Ni foam-supported silver nanoplates-PANI 3D architecture electrode for enzyme-free glucose sensing.

Reliable and cost-effective glucose sensors are in rising demand among diabetes patients. The combination of metals and conducting polymers creates a robust electrocatalyst for glucose oxidation, offering enzyme-free, high stability, and sensitivity with outstanding electrochemical results. Herein, graphene is grown on nickel foam by chemical vapor deposition to make a graphene@nickel foam scaffold (G@NF), on which silver nanoplates-polyaniline (Ag-PANI) 3D architecture is developed by sonication-assisted co-electrodeposition. The resulting binder-free 3D Ag-PANI/G@NF electrode was highly porous, as characterized by x-ray photoelectron spectroscopy, Field emission scanning electron microscope, x-ray diffractometer, FTIR, and Raman spectroscopy. The binder-free 3D Ag-PANI/G@NF electrode exhibits remarkable electrochemical efficiency with a superior electrochemical active surface area. The amperometric analysis provides excellent anti-interference performance, a low limit of deduction (0.1 nM), robust sensitivity (1.7 × 1013µA mM-1cm-2), and a good response time. Moreover, the Ag-PANI/G@NF enzyme-free sensor is utilized to observe glucose levels in human blood serums and exhibits excellent potential to become a reliable clinical glucose sensor.

Upper gastrointestinal cancers: Trends and determinants of location of death.

BACKGROUND: Patients diagnosed with upper gastrointestinal cancers often require extensive end-of-life care. We sought to investigate social determinants of health associated with disparities in the location of death among patients who died of upper gastrointestinal cancers. METHODS: Patients who died between 2003 and 2020 from esophageal cancer, gastric cancer, hepatobiliary cancer, and pancreatic cancer were identified using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Social determinants of health were assessed using the Social Vulnerability Index. Patients were categorized on the basis of location of death: inpatient hospital, home, nursing home, hospice, and outpatient medical facility/emergency department. Multivariable regression and mediation analyses defined the association of patient race as well as social determinants of health with location of death. RESULTS: Among 815,780 decedents (esophageal cancer: 15.3%; gastric cancer: 3.6%; hepatobiliary cancer: 36.6%; pancreatic cancer: 54.5%), most were male (60.8%), aged 55-74 years (52.3%), and White (89.1%). Most decedents died at home (55.7%), followed by inpatient hospital (24.8%), hospice (9.0%), nursing home (8.1%), and outpatient medical facility/emergency department (2.5%). During the study period, location of death shifted notably from inpatient hospital (36.8% to 21.3%) to home (45.8% to 56.3%). Residents of high Social Vulnerability Index areas were more likely to die at inpatient hospital compared with home (31.8% vs 24.3%) (P < .001). Black race (reference: White; odds ratio; 0.41, 95% confidence interval, 0.40-0.42) and social vulnerability (reference: low Social Vulnerability Index; odds ratio, 0.64, 95% confidence interval, 0.63-0.65) remained independently associated with lower odds of dying at home compared with an inpatient hospital. Notably, 65% of the overall race-based association with death at inpatient hospital was driven indirectly through social determinants of health. CONCLUSION: Social determinants are important drivers of end-of-life care and impact the potential ability of patients with cancer to die at home.

Development of an artificial intelligence-based model to predict early recurrence of neuroendocrine liver metastasis after resection.

PURPOSE: We sought to develop an artificial intelligence (AI)-based model to predict early recurrence (ER) after curative-intent resection of neuroendocrine liver metastases (NELMs). METHODS: Patients with NELM who underwent resection were identified from a multi-institutional database. ER was defined as recurrence within 12 months of surgery. Different AI-based models were developed to predict ER using 10 clinicopathologic factors. RESULTS: Overall, 473 patients with NELM were included. Among 284 patients with recurrence (60.0%), 118 patients (41.5%) developed an ER. An ensemble AI model demonstrated the highest area under receiver operating characteristic curves of 0.763 and 0.716 in the training and testing cohorts, respectively. Maximum diameter of the primary neuroendocrine tumor, NELM radiologic tumor burden score, and bilateral liver involvement were the factors most strongly associated with risk of NELM ER. Patients predicted to develop ER had worse 5-year recurrence-free survival and overall survival (21.4% vs 37.1% [P = .002] and 61.6% vs 90.3% [P = .03], respectively) than patients not predicted to recur. An easy-to-use tool was made available online: (https://altaf-pawlik-nelm-earlyrecurrence-calculator.streamlit.app/). CONCLUSION: An AI-based model demonstrated excellent discrimination to predict ER of NELM after resection. The model may help identify patients who can benefit the most from curative-intent resection, risk stratify patients according to prognosis, as well as guide tailored surveillance and treatment decisions including consideration of nonsurgical treatment options.

The Association of Socio-Environmental Inequality and Outcomes Among Patients Undergoing Major Surgery.

INTRODUCTION: Environmental hazards may influence health outcomes and be a driver of health inequalities. We sought to characterize the extent to which social-environmental inequalities were associated with surgical outcomes following a complex operation. METHODS: In this cross-sectional study, patients who underwent abdominal aortic aneurysm repair, coronary artery bypass grafting, colectomy, pneumonectomy, or pancreatectomy between 2016 and 2021 were identified from Medicare claims data. Patient data were linked with social-environmental data sourced from Centers for Disease Control and Agency for Toxic Substances and Disease Registry data based on county of residence. The Environmental Justice Index social-environmental ranking (SER) was used as a measure of environmental injustice. Multivariable regression analysis was performed to assess the relationship between SER and surgical outcomes. RESULTS: Among 1,052,040 Medicare beneficiaries, 346,410 (32.9%) individuals lived in counties with low SER, while 357,564 (33.9%) lived in counties with high SER. Patients experiencing greater social-environmental injustice were less likely to achieve textbook outcome (odds ratio 0.95, 95% confidence interval 0.94-0.96, P < 0.001) and to be discharged to an intermediate care facility or home with a health agency (odds ratio 0.97, 95% confidence interval 0.96-0.98, P < 0.001). CONCLUSIONS: Cumulative social and environmental inequalities, as captured by the Environmental Justice Index SER, were associated with postoperative outcomes among Medicare beneficiaries undergoing a range of surgical procedures. Policy makers should focus on environmental, as well as socioeconomic injustice to address preventable health disparities.

A Comparative Study Based on Petrophysical and Cluster Analysis Approach for Identification of Rock Types in Heterogeneous Sandstone Reservoirs.

To delineate a powerful reservoir model, rock type identification is an essential task. Recognizing intervals with promising reservoir quality in a heterogeneous reservoir, such as the Pab Formation, using well logs is critical for better exploration, because coring programs are always impractical due to time and cost constraints. Rock types are described by specific log responses, which are ultimately distinguished with the help of electrofacies. The current study uses a cluster analysis technique for the evaluation of reservoir rock types in the identified sand units. K-means cluster analysis is employed to define electrofacies, which are ultimately classified into four rock types on the basis of reservoir quality, from bad to excellent. Rock typing using cluster analysis has been done for four wells, and a correlation has been made to depict changes in electrofacies. From well-to-well correlation, it can be inferred that the reservoir quality of the Pab Formation at the lower portion of Zamzama-02 and 05 wells is excellent and is defined by rock type 4. The Zamzama-03 well in the southwestern region, on the other hand, has good to moderate reservoir quality, as demonstrated by dominating rock types 3 and 2, respectively. The applied prediction technique to the studied field provides continuous rock type identification for the entire reservoir. Using this methodology in defining rock type is cost-effective, requires less time in the demarcation of zones of interest, and is more accurate than manual analysis of the heterogeneous and thick Pab Formation. The studied approach is not only useful in the exploitation of the heterogeneous Pab Formation but also can be applied to other heterogeneous sandstone reservoirs elsewhere.

The Association of Established Primary Care with Postoperative Outcomes Among Medicare Patients with Digestive Tract Cancer.

BACKGROUND: Primary care (PC) is essential to overall wellness and management of comorbidities. In turn, patients without adequate access to PC may face healthcare disparities. We sought to characterize the impact of established PC on postoperative outcomes among patients undergoing a surgical procedure for a digestive tract cancer. METHODS: Medicare beneficiaries with a diagnosis of hepatobiliary, pancreas, and colorectal cancer between 2005 and 2019 were identified within the Surveillance, Epidemiology, and End Results program and Medicare-linked database. Individuals who did versus did not have PC encounters within 1-year before surgery were identified. A postoperative textbook outcome (TO) was defined as the absence of complications, no prolonged hospital stay, no readmission within 90 days, and no mortality. RESULTS: Among 63,177 patients, 50,974 (80.7%) had at least one established PC visit before surgery. Patients with established PC were more likely to achieve TO (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09-1.19) with lower odds for complications (OR, 0.85; 95% CI, 0.72-0.89), extended hospital stay (OR, 0.86; 95% CI, 0.81-0.94), 90-day readmission (OR, 0.94; 95% CI, 0.90-0.99), and 90-day mortality (OR, 0.87; 95% CI, 0.79-0.96). In addition, patients with established PC had a 4.1% decrease in index costs and a 5.2% decrease in 1-year costs. Notably, patients who had one to five visits with their PC in the year before surgery had improved odds of TO (OR, 1.21; 95% CI, 1.16-1.27), whereas individuals with more than 10 visits had lower odds of a postoperative TO (OR, 0.91; 95% CI, 0.84-0.98). CONCLUSION: Most Medicare beneficiaries with digestive tract cancer had established PC within the year before their surgery. Established PC was associated with a higher probability of achieving ideal outcomes and lower costs. In contrast, patients with more than 10 PC appointments, which was likely a surrogate of overall comorbidity burden, experienced no improvement in postoperative outcomes.

Machine learning models including preoperative and postoperative albumin-bilirubin score: short-term outcomes among patients with hepatocellular carcinoma.

BACKGROUND: We sought to assess the impact of various perioperative factors on the risk of severe complications and post-surgical mortality using a novel maching learning technique. METHODS: Data on patients undergoing resection for HCC were obtained from an international, multi-institutional database between 2000 and 2020. Gradient boosted trees were utilized to construct predictive models. RESULTS: Among 962 patients who underwent HCC resection, the incidence of severe postoperative complications was 12.7% (n = 122); in-hospital mortality was 2.9% (n = 28). Models that exclusively used preoperative data achieved AUC values of 0.89 (95%CI 0.85 to 0.92) and 0.90 (95%CI 0.84 to 0.96) to predict severe complications and mortality, respectively. Models that combined preoperative and postoperative data achieved AUC values of 0.93 (95%CI 0.91 to 0.96) and 0.92 (95%CI 0.86 to 0.97) for severe morbidity and mortality, respectively. The SHAP algorithm demonstrated that the factor most strongly predictive of severe morbidity and mortality was postoperative day 1 and 3 albumin-bilirubin (ALBI) scores. CONCLUSION: Incorporation of perioperative data including ALBI scores using ML techniques can help risk-stratify patients undergoing resection of HCC.

Association of county-level provider density with hepatobiliary cancer incidence and mortality.

BACKGROUND: Access to healthcare providers is a key factor in reducing cancer incidence and mortality, underscoring the significance of provider density as a crucial metric of health quality. We sought to characterize the association of provider density on hepatobiliary cancer population-level incidence and mortality. STUDY DESIGN: County-level hepatobiliary cancer incidence and mortality data from 2016 to 2020 and provider data from 2016 to 2018 were obtained from the CDC and Area Health Resource File. Multivariable logistic regression was utilized to evaluate the relationship between provider density and hepatobiliary cancer incidence and mortality. RESULTS: Among 1359 counties, 851 (62.6%) and 508 (37.4%) counties were categorized as urban and rural, respectively. The median number of providers in any given county was 104 (IQR: 44-306), while provider density was 120.1 (IQR: 86.7-172.2) per 100,000 population; median household income was $51,928 (IQR: $45,050-$61,655). Low provider-density counties were more likely to have a greater proportion of residents over 65 years of age (52.7% vs. 49.6%) who were uninsured (17.4% vs. 13.2%) versus higher provider-density counties (p < 0.05). Moreover, all-stage incidence, late-stage incidence, and mortality rates were higher in counties with low provider density. On multivariable analysis, moderate, and high provider density were associated with lower odds of all-stage incidence, late-stage incidence, and mortality. CONCLUSION: Higher county-level provider density was associated with lower hepatobiliary cancer-related incidence and mortality. Efforts to increase access to healthcare providers may improve healthcare equity as well as long-term cancer outcomes.

Community Privilege and Unplanned Surgery for Access-Sensitive Surgical Conditions.

OBJECTIVE: We sought to define the association of privilege on rates of unplanned surgery and perioperative outcomes for access-sensitive surgical conditions. BACKGROUND: Social determinants of health (SDOH) are critical in influencing timely access to healthcare. Privilege represents a right, benefit, advantage, or opportunity that positively influences all SDOH. METHODS: The California Department of Health Care Access and Information (HCAI) database identified patients who underwent abdominal aortic aneurysm repair, ventral hernia repair, or colectomy for colon cancer between 2017 and 2020 and was merged using ZIP codes with the Index of Concentration of Extremes, a validated measure of racial and economic privilege obtained from the American Community Survey. Clustered multivariable regression was performed to assess the association between privilege and outcomes. RESULTS: Among 185,316 patients who underwent a surgical procedure for one of three access-sensitive surgical conditions, roughly 1 in 5 individuals resided in areas with the highest (Q5; n=37,308; 20.1%) or lowest (Q1; n=36,352, 19.6%) privilege. Nearly one-half of the surgeries were unplanned (n=88,814, 46.9%), and colectomy for colon cancer was the most performed emergent procedure. Patients residing in the lowest privileged areas had higher rates of unplanned surgery compared with those residing in the highest privilege (Q1; 55.4% vs. 39.4%; referent: Q5; adjusted odds ratio [OR], 1.23, 95%CI 1.16-1.31; P<0.001). For each access-sensitive surgical condition, patients in the least privileged areas were more likely to experience higher rates of inpatient mortality (Q1; 3.1% vs. 2.1%; referent: Q5; adjusted OR, 1.41, 95%CI 1.24-1.60; P<0.001), perioperative complications (Q1; 30.4% vs. Q5; 23.8%; referent: Q5; adjusted OR, 1.24, 95%CI 1.18-1.31; P<0.001) and extended hospital stays (Q1; 26.3% vs. 20.1%; referent: Q5; adjusted OR, 1.16, 95%CI 1.09-1.22; P<0.001). CONCLUSIONS AND RELEVANCE: Privilege was associated with rates of unplanned surgery and adverse clinical outcomes. This indicates the role privilege as a key SDOH that influences patient access to and quality of surgical care.