Disparities in brachytherapy utilization in cervical cancer in the United States: A comprehensive literature review.

Brachytherapy (BT) is an integral component of treatment for patients with locally advanced cervical cancer, significantly improving local control and overall survival. There is an overall trend of decreased utilization of BT in United States (US) in the last few decades with around 50% of patients being treated without BT. The cause of decreased utilization is multifactorial including physician comfort, facility volume, low reimbursements rates and costs of starting and maintaining a brachytherapy program. This decrease coincides with an increase in the use of newer advanced techniques like intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) boost resulting in inferior oncological outcomes and increased toxicity. Moreover, racial and socioeconomic disparities in BT utilization have been widely reported in the US. Various factors including age, race, socio-economic status, location, facility type, facility volume and insurance status result in limited access to brachytherapy, which jeopardizes oncologic outcomes. This comprehensive review discusses the BT utilization in the US, examines the impact of race and socioeconomic factors on BT utilization, and highlights its impact on outcomes.

Variation of Hg concentration and accumulation in the soil of maritime pine plantations along a coast-inland transect in SW Europe.

Climatic conditions have been shown as a major driver of the fate of Hg in forest ecosystems at a global scale, but less is known about climatic effects at shorter scales. This study assesses whether the concentration and pools of Hg in soils collected from seventeen Pinus pinaster stands describing a coastal-inland transect in SW Europe vary along a regional climatic gradient. In each stand, samples of the organic subhorizons (OL, OF + OH) and the mineral soil (up to 40 cm) were collected and some general physico-chemical properties and total Hg (THg) were analyzed. Total Hg was significantly higher in the OF + OH than in the OL subhorizons (98 and 38 µg kg-1, respectively), favored by a greater organic matter humification in the former. In the mineral soil, mean THg values decreased with depth, ranging from 96 µg kg-1 in the 0-5 cm layers to 54 µg kg-1 in the deepest layers (30-40 cm), respectively. The average Hg pool (PHg) was 0.30 mg m-2 in the organic horizons (92% accumulated in the OF + OH subhorizons), and 27.4 mg m-2 in the mineral soil. Changes in climatic factors, mainly precipitation, along the coast-inland transect resulted in a remarkable variation of THg in the OL subhorizons, consistent with their role as the first receiver of atmospheric Hg inputs. The high precipitation rate and the occurrence of fogs in coastal areas characterized by the oceanic influence would explain the higher THg found in the uppermost soil layers of pine stands located close to the coastline. The regional climate is key to the fate of mercury in forest ecosystems by influencing the plant growth and subsequent atmospheric Hg uptake, the atmospheric Hg transference to the soil surface (wet and dry deposition and litterfall) and the dynamics that determine net Hg accumulation in the forest floor.

A Prospective Study of Social Needs Associated with Mental Health among Postpartum Patients Living in Underserved Communities.

OBJECTIVE: Given the rising rates of maternal morbidity and mortality in the United States and the contribution of mental illness, especially among individuals living in underresourced communities, the objective was to evaluate the prevalence of unmet health-related social needs and their impact on perinatal mental health outcomes. STUDY DESIGN: This was a prospective observational study of postpartum patients residing within regions with increased rates of poor perinatal outcomes and sociodemographic disparities. Patients were enrolled in a multidisciplinary public health initiative "extending Maternal Care After Pregnancy (eMCAP)" between October 1, 2020 and October 31, 2021. Unmet health-related social needs were assessed at delivery. Symptoms of postpartum depression and anxiety were evaluated at 1 month postpartum utilizing the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD7) screening tools, respectively. Mean EPDS and GAD7 scores and odds of screening positive (scoring ≥ 10) were compared among individuals with and without unmet health-related social needs with p < 0.05 considered significant. RESULTS: Of participants enrolled in eMCAP, 603 completed at least one EPDS or GAD7 at 1 month. Most had at least one social need, most commonly dependence on social programs for food (n = 413/603; 68%). Individuals lacking transportation to medical (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.2-13.32) and nonmedical appointments (OR: 4.17, 95% CI: 1.08-16.03) had significantly higher odds of screening positive on EPDS while participants lacking transportation to medical appointments (OR: 2.73, 95% CI: 0.97-7.70) had significantly higher odds of screening positive on GAD7. CONCLUSION: Among postpartum individuals in underserved communities, social needs correlate with higher depression and anxiety screening scores. This highlights the need to address social needs to improve maternal mental health. KEY POINTS: · Social needs are prevalent among underserved patients.. · Needs can be assessed in a structured or freeform manner.. · Unmet needs correlate with poor mental health outcomes.. · Similar needs correlate with depression and anxiety..

The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study.

BACKGROUND: Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes. METHODS: 1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category. RESULTS: The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02-1.97 and 2.78, 95% CI 1.83-4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06-2.74, and 2.62, 95% CI 1.65-4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42-0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03-2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50-3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight. CONCLUSIONS: EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.

Needle age and precipitation as drivers of Hg accumulation and deposition in coniferous forests from a southwestern European Atlantic region.

Vegetation and climate are critical in the biogeochemical cycle of Hg in forest ecosystems. The study assesses the influence of needle age and precipitation on the accumulation of Hg in needle biomass and its deposition by litterfall in thirty-one pine plantations spread throughout two biogeographical regions in SW Europe. Well-developed branches of Pinus pinaster were sampled and pine needles were classified according to 4 age classes (y0, y1, y2, y3). The concentration of total Hg (THg) was analyzed in the samples and Hg content in needle biomass and its deposition by litterfall were estimated. The concentration of total Hg (THg) increased with needle age ranging from 9.1 to 32.7 µg Hg kg-1 in the youngest and oldest needles, respectively. The rate of Hg uptake (HgR) three years after needle sprouting was 10.2 ± 2.3 µg Hg kg-1 yr-1, but it decreased with needle age probably due to a diminution in photosynthetic activity as needles get older. The average total Hg stored in needle biomass (HgWt) ranged from 5.6 to 87.8 mg Hg ha-1, with intermediate needle age classes (y1 and y2) accounting for 70% of the total Hg stored in the whole needle biomass. The average deposition flux of Hg through needle litterfall (HgLt) was 1.5 µg Hg m-2 yr-1, with the y2 and y3 needles contributing most to the total Hg flux. The spatial variation of THg, HgWt and HgLt decreased from coastal pine stands, characterized by an oceanic climate, to inland pine stands, a feature closely related to the dominant precipitation regime in the study area. Climatic conditions and needle age are the main factors affecting Hg accumulation in tree foliage, and should be considered for an accurate assessment of forest Hg pools at a regional scale and their potential consequences in the functioning of terrestrial ecosystems.

Physiological demands and nutrient intake modulate a trade-off between dispersal and reproduction based on age and sex of field crickets.

Animals adjust resource acquisition throughout life to meet changing physiological demands of growth, reproduction, activity and somatic maintenance. Wing-polymorphic crickets invest in either dispersal or reproduction during early adulthood, providing a system in which to determine how variation in physiological demands, determined by sex and life history strategy, impact nutritional targets, plus the consequences of nutritionally imbalanced diets across life stages. We hypothesized that high demands of biosynthesis (especially oogenesis in females) drive elevated resource acquisition requirements and confer vulnerability to imbalanced diets. Nutrient targets and allocation into key tissues associated with life history investments were determined for juvenile and adult male and female field crickets (Gryllus lineaticeps) when given a choice between two calorically equivalent but nutritionally imbalanced (protein- or carbohydrate-biased) artificial diets, or when restricted to one imbalanced diet. Flight muscle synthesis drove elevated general caloric requirements for juveniles investing in dispersal, but flight muscle quality was robust to imbalanced diets. Testes synthesis was not costly, and life history investments by males were insensitive to diet composition. In contrast, costs of ovarian synthesis drove elevated caloric and protein requirements for adult females. When constrained to a carbohydrate-biased diet, ovary synthesis was reduced in reproductive morph females, eliminating their advantage in early life fecundity over the dispersal morph. Our findings demonstrate that nutrient acquisition modulates dispersal-reproduction trade-offs in an age- and sex-specific manner. Declines in food quality will thus disproportionately affect specific cohorts, potentially driving demographic shifts and altering patterns of life history evolution.

Soil properties influencing Hg vertical pattern in temperate forest podzols.

Mercury content of twelve podzols from NW Spain was studied to elucidate the main soil properties involved in the Hg accumulation of these soils. The highest average Hg concentrations (HgT) were found in the Bh and Bs horizons (64 and 105 µg kg-1), whereas the lowest occurred in the E horizons (15 µg kg-1). Moderate values of HgT were obtained for the A and C horizons (38 and 52 µg kg-1). The Hg enrichment factors revealed that the predominant origin of Hg in these soils is the atmosphere instead of the parent material. As it was shown by the PCA performed (which explained 82% of the variance of the data), the main soil characteristics involved in the pedogenetic processes of the studied podzols are organic matter and Al and Fe compounds. The stepwise linear regressions made described between 54% and 84% of the predicted Hg depending on the soil horizon. Besides a complex ensemble of biogeochemical reactions involved in the balance between input and outputs of Hg, the most influencing variable in the A horizons was organic C, moderate stability Al-humus complexes in the E horizons, Fe-humus complexes and pHw in the Bh horizons, Al-humus compounds in the Bs horizons and crystalline Al and Fe compounds in the C horizons. Therefore, Hg is mobilized from the A and E horizons bound to dissolved organic matter and precipitated in the illuvial horizons due to the saturation of the organic matter with metals. The immobilization of Hg in the subsuperficial horizons of podzols leads to different environmental benefits derived from the removal of Hg from the A horizons, more exposed to climate-induced and land use/cover changes that could potentially modify the dynamics of Hg in those superficial horizons.

Speech Sound Disorder and Visual Biofeedback Intervention: A Preliminary Investigation of Treatment Intensity.

A growing body of research suggests that cases of speech sound errors that have not responded to previous intervention can sometimes be eliminated through speech therapy incorporating visual biofeedback. Aside from considerations related to the specific biofeedback type, acquisition and generalization of a motor plan may be linked to treatment intensity. Several researchers have raised the possibility that inadequate dosage levels may present a significant barrier to success. Thus, the current study aimed to assess the relationship between treatment intensity and treatment outcomes. Twenty-nine articles reporting the use of visual biofeedback intervention for speech sound disorder were identified and coded for treatment intensity using the cumulative intervention index and outcomes using mean level difference scores. Findings reveal small but significant relationships between measures of treatment intensity and efficacy, which should be interpreted with caution given the preliminary nature of this review. Further research in this area is necessary, as inconsistencies in reporting intensity and outcomes across studies underscore the need for more systematic terminology and reporting methods.

Social and environmental determinants of physical activity in urban parks: Testing a neighborhood disorder model.

The current study examined the nexus of neighborhood disorder-in the form of physical disorder (e.g., broken glass and vandalism) and social disorder (e.g., public drinking and lewd conduct)-and physical activity (PA) in urban public parks to inform public policy addressing chronic disease in at-risk populations. Five hundred and twenty-two unique observations were conducted in 22 public parks from March to September 2016. The study utilized the System for Observing Play and Recreation in Communities (SOPARC) to document age, gender, ethnicity, and PA level of park users. The Physical Activity Resource Assessment (PARA) was used to document observed physical and social disorder incivilities in public parks included in the current study. Males, adults, and Latina/os accounted for the largest number of park users, respectively. Significant PA differences were observed across gender, age, and ethnicity. Multiple linear regression controlling for gender, age, and ethnicity found physical disorder, but not social disorder, generally predicted PA reductions. While it has been demonstrated that physical disorder predicts PA reductions in low-income communities of color, this is the first study to reveal that physical disorder may lead to decreased PA in urban public parks. Thus, remediation of public park incivilities characterized by physical disorder, paired with community outreach, may lead to increased PA in at-risk communities.