Characteristics of lung cancer screening eligible population in the US and prediction of the eligibility with simplified criteria.

Background: In 2021, updates to the lung cancer screening (LCS) guidelines extended the eligibility to include younger individuals and those with lower lifetime smoking intensity. A significant challenge in the LCS implementation is identifying eligible individuals because lifetime smoking intensity, a key criterion of current guidelines, is typically unavailable in electronic health records and difficult to assess accurately. This study aimed to (I) examine the characteristics of the eligible population in the US based on current guidelines and (II) evaluate the performance of five simplified criteria as alternative tools for predicting LCS eligibility. Methods: National Health and Nutrition Examination Survey (NHANES) 2013-2018 data were used. Five simplified criteria were: (I) ever smoker, defined as an individual with any positive smoking history; (II) current or former smoker, an individual with any positive smoking history or who quit smoking within 15 years; (III) current smoker, an individual currently smoking; (IV) current smoker, an individual currently smoking >0.5 packs per day (ppd); (V) current smoker, a person currently smoking >1 ppd. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The complex survey design was considered. Results: About 16.70 million individuals (representing 16.01% of population aged 50-80 years) were eligible for LCS in the US. The percentage of LCS eligibility was higher among people who were younger, male, non-Hispanic White, less educated, single, not insured, with poorer health status and lower socioeconomic status. Except for the criterion of current smoker with >1 ppd having low sensitivity (0.08), other criteria had sensitivity ranging between 0.45 and 1.00. The accuracy of the five criteria used ranged between 0.70 and 0.91. Conclusions: Individuals with less favorable social and clinical characteristics have higher chances of being eligible for LCS, potentially amplifying disparities in LCS utilization. Simplified criteria can be used as prescreening tools to identify target populations, which could facilitate LCS implementation at the population level.

Medicaid Expansion Increases Access for Rural and Impoverished Patients with Pancreatic Ductal Adenocarcinoma in Southern States.

INTRODUCTION: Medicaid expansion (ME) impacted patients when assessed at a national level. However, of the 32 states in which Medicaid expansion occurred, only 3 were Southern states. Whether results apply to Southern states that share similar geopolitical perspectives remains elusive. We aimed to assess the impact of ME on pancreatic ductal adenocarcinoma (PDAC) treatment in eight Southern states in the USA. PATIENTS AND METHODS: We identified uninsured or Medicaid patients (age 40-64 years) diagnosed with PDAC between 2011 and 2018 in Southern states from the North American Association of Central Cancer Registries-Cancer in North America (NAACCR-CiNA) research dataset. Medicaid-expanded states (MES; Louisiana, Kentucky, and Arkansas) were compared with non-MES (NMES; Tennessee, Alabama, Mississippi, Texas, and Oklahoma) using multivariate logistic regression. P < 0.05 was considered statistically significant. RESULTS: Among 3036 patients, MES significantly increased odds of Medicaid insurance by 36%, and increased proportions of insured Black patients by 3.7%, rural patients by 3.8%, and impoverished patients by 18.4%. After adjusting for age, race, rural-urban status, poverty status, and summary stage, the odds of receiving radiation therapy decreased by 26% for each year of expansion in expanded states (P = 0.01). Last, ME did not result in a significant difference between MES and NMES in diagnosing early stage disease (P = 0.98) nor in receipt of chemotherapy or surgery (P = 0.23 and P = 0.63, respectively). CONCLUSIONS: ME in Southern states increased insurance access to traditionally underserved groups. Interestingly, ME decreased the odds of receiving radiation therapy yearly and had no significant impact on receipt of chemotherapy or surgery.

The Effect of Minority Stress Processes on Stage of Change and Nicotine Dependence Level for Sexual and Gender Minority Smokers in the Deep South.

Purpose: Minority stress has been posited as a cause for sexual and gender minority (SGM) individuals to smoke as a coping mechanism. The purpose of this study was to elucidate the relationship between minority stress processes and nicotine dependence level and stage of change for SGM smokers living in the Deep South region of the United States. Methods: A one-time, cross-sectional online survey was administered to SGM smokers living in the Deep South. Survey measurements included demographics, minority stress processes (prejudice events, perceived stigma, and internalized queerphobia), and smoking cessation outcomes (nicotine dependence level and stage of change). Multivariable linear regression was used to assess the effect of each minority stress process on smoking outcomes, after adjusting for demographics and stratifying by gender and sexual identity. Results: Across all participants (n = 1296), lower levels of perceived stigma were significantly associated with further stage of change. Greater levels of internalized queerphobia were significantly associated with greater nicotine dependence level. After stratifying by gender and sexual identity, these significant associations were only maintained in cisgender males and gay individuals. An additional significant association between lower prejudice events and further stage of change for smoking cessation was found only for individuals whose sexual identity was labeled as "other." Conclusion: Addressing minority stress in smoking cessation and prevention programs has the potential to decrease nicotine dependence and further stage of change.

Effect of chronic disease on racial difference in COVID-19-associated hospitalization among cancer patients.

BACKGROUND: Research indicates that Black cancer patients have higher rates of COVID-19 hospitalization than their White counterparts. However, the extent to which chronic diseases contribute to racial disparities remains uncertain. We aimed to quantify the effect of chronic diseases on racial disparity in COVID-19-associated hospitalization among cancer patients. METHODS: We linked Louisiana Tumor Registry's data with statewide COVID-19 data and hospital in-patient discharge data to identify patients diagnosed with cancer in 2015-2019 who tested positive for COVID-19 in 2020 and those with COVID-19-associated hospitalization. Multivariable logistic regression and mediation methods based on linear structural equations were employed to assess the effects of the number of chronic diseases (0, 1-2, ≥3) and individual chronic diseases. RESULTS: Of 6381 cancer patients who tested positive for COVID-19, 31.6% were non-Hispanic Black cancer patients. Compared with non-Hispanic White cancer patients, non-Hispanic Black cancer patients had a higher prevalence of chronic diseases (79.5% vs 66.0%) and higher COVID-19-associated hospitalization (27.2% vs 17.2%). The odds of COVID-19-associated hospitalization were 80% higher for non-Hispanic Black cancer patients than non-Hispanic White cancer patients (odds ratio = 1.80, 95% confidence interval = 1.59 to 2.04). After adjusting for age, sex, insurance, poverty, obesity, and cancer type, number of chronic diseases explained 37.8% of the racial disparity in COVID-19-associated hospitalization, and hypertension, diabetes, and chronic renal disease were the top 3 chronic diseases explaining 9.6%, 8.9%, and 7.3% of the racial disparity, respectively. CONCLUSION: Chronic diseases played a substantial role in the racial disparity in COVID-19-associated hospitalization among cancer patients, especially hypertension, diabetes, and renal disease. Understanding and addressing the root causes are crucial for targeted interventions, policies, and health-care strategies to reduce racial disparity.

Impact of Medicaid Expansion on Breast Cancer Diagnosis and Treatment in Southern States.

BACKGROUND: Medicaid expansion impacted patients when assessed at a national level. However, of the 32 states that expanded Medicaid, only three were Southern states. Whether results apply to Southern states that share similar geopolitical perspectives remains elusive. We aimed to assess the impact of Medicaid expansion on breast cancer diagnosis and treatment in 8 Southern states in the US. STUDY DESIGN: We identified uninsured or Medicaid patients (age 40 to 64 years) diagnosed with invasive breast cancer from 2011 to 2018 in Southern states from the North American Association of Central Cancer Registries-Cancer in North America Research Dataset. Medicaid-expanded states ([MES], Louisiana, Kentucky, Arkansas) were compared with non-MES ([NMES], Tennessee, Alabama, Mississippi, Texas, Oklahoma) using multivariate logistic regression and differences-in-differences analyses during pre- and postexpansion periods; p < 0.05 was considered statistically significant. RESULTS: Among 21,974 patients, patients in MES had increased odds of Medicaid insurance by 43% (odds ratio 1.43, p < 0.01) and decreased odds of distant-stage disease by 7% (odds ratio 0.93, p = 0.03). After Medicaid expansion, Medicaid patients increased by 10.6% in MES (Arkansas, Kentucky), in contrast to a 1.3% decrease in NMES (differences-in-differences 11.9%, p < 0. 0001, adjusting for age, race/ethnicity, rural-urban status, and poverty status). MES (Arkansas, Kentucky) had 2.3% fewer patients diagnosed with distant-stage disease compared with a 0.5% increase in NMES (differences-in-differences 2.8%, p = 0.01, after adjustment). Patients diagnosed in MES had higher odds of receiving treatment (odds ratio 2.27, p = 0.03). CONCLUSIONS: Unlike NMES, MES experienced increased Medicaid insured, increased treatment, and decreased distant-stage disease at diagnosis. Medicaid expansion in the South leads to earlier and more comprehensive treatment of breast cancer.

The prevalence of developmental dental and eruption anomalies assessed using panoramic radiographs: a retrospective study.

Developmental dental anomalies are a common finding in adolescent populations. The objective of this study was to utilize panoramic radiographs to determine the prevalence of dental anomalies and developmental disturbances in a heterogenous adolescent orthodontic patient population seeking care at a North American orthodontic residency program. A total of 1042 panoramic radiographs of 457 male and 585 female orthodontic patients aged 10 to 18 years were evaluated. Developmental and eruption anomalies were recorded and categorized, and chi-square and Fisher exact tests were used for statistical analysis. The evaluation revealed that 40.88% of patients had at least 1 anomalous finding. The most common finding overall was agenesis (12.00%), followed by deviations in eruption path (9.12%), delayed eruption (7.39%), and impaction (7.29%). There was no difference in the prevalence of having any anomalous finding or the prevalence of any specific category of anomalies based on the sex or Angle classification of the patients. Comparison of developmental dental anomalies in 3 age groups (10 to 12, 13 to 15, or 16 to 18 years) revealed no statistically significant difference in the overall prevalence of anomalous findings. Statistically significant differences for some specific categories of anomalies were explainable by correlating dental development with chronologic age, such as a greater frequency of blocked out teeth and eruption path deviation among patients aged 10 to 12 years. Black patients were found to have a significantly greater prevalence of impactions (P = 0.030), and Asian patients had a significantly greater prevalence of anomalies categorized as "other pathology," which could not be definitively diagnosed by panoramic radiograph alone (P = 0.007).

Bone Regeneration in Maxillary Sinus Augmentation Using Advanced Platelet-Rich Fibrin (A-PRF) and Plasma Rich in Growth Factors (PRGF): A Pilot Randomized Controlled Trial

The purpose of this pilot randomized controlled trial was to analyze and compare the effects of advanced platelet-rich fibrin (A-PRF) and plasma rich in growth factors (PRGF) combined with deproteinized bovine bone mineral (DBBM) on bone regeneration outcomes in maxillary sinus augmentation (MSA) procedures. A total of 15 patients in need of MSA were consecutively recruited. Maxillary sinuses were grafted with DBBM alone (control group), DBBM mixed with A-PRF (PRF group), or DBBM mixed with PRGF (PRGF group). After a 6-month healing period, bone core biopsy samples were collected prior to implant placement for histologic and histomorphometric analyses. The mean percentage of mineralized tissue (MT) was 20.33 ± 11.50 in the control group, 32.20 ± 7.29 for the PRF group, and 34.80 ± 6.83 for the PRGF group, with no statistically significant differences across the three groups (P > .05). The mean percentage of remaining bone grafting material (RBGM) was 24.00 ± 7.94 for the control group, 26.00 ± 7.78 for the PRF group, and 15.80 ± 8.23 for the PRGF group, with no statistically significant differences across the three groups (P > .05). Finally, the mean percentage of nonmineralized tissue (NMT) was 55.66 ± 7.77 for the control group, 41.40 ± 8.32 for the PRF group, and 49.60 ± 5.68 for the PRGF group, with no statistically signifcant differences across the three groups (P > .05). These findings suggest that the addition of A-PRF and PRGF to DBBM does not enhance new bone formation outcomes in maxillary sinus augmentation procedures. Neither of the two platelet concentrates were superior to the other in any of the variables assessed.

Distance to radiation therapy facility influences surgery type among older women with early-stage breast cancer.

BACKGROUND: Breast-conserving surgery plus radiation (BCT) yields equivalent or better survival than mastectomy for early-stage breast cancer (ESBC) women. However, nationwide mastectomy trends increased in recent decades, attracting studies on underlying causes. Prior research identified that long distance to the radiation treatment facility (RTF) was associated with mastectomy. Still, it is unclear whether such association applies to young and old ESBC women comparably. We sought to delineate such impacts by age. METHODS: Women diagnosed with stages 0-II breast cancer in 2013-2017 receiving either BCT or mastectomy were identified from the Louisiana Tumor Registry. We assessed the association of surgery (mastectomy vs. BCT) with the distance to the nearest or nearest accessible RTFs using multivariable logistic regression adjusting the socio-demographic and tumor characteristics. The nearest accessible RTF was determined based on patients' health insurance. For Medicaid, uninsured, and unknown insurance patients, the nearest accessible RTF is the nearest RTF owned by the government. The interaction effect of age and distance was evaluated as well. RESULTS: Of 11,604 patients, 46.7% received mastectomy. Compared with distance ≤5 miles to the nearest RTF, those with distance ≥40 miles or 15-40 miles had higher odds of mastectomy (adjusted (adj) OR = 1.39, 95% CI = 1.07-1.82; adj OR = 1.17, 95% CI = 1.02-1.34). To the nearest accessible RTF, the adj ORs were 1.25 (95% CI = 1.03-1.51) and 1.19 (95% CI = 1.04-1.35), respectively. Age-stratified analysis showed the significant association (p < 0.05) only presented among women aged ≥65, but not those aged <65 years. CONCLUSION: Distance to the nearest or nearest accessible RTF influences the surgery choice, especially among women in Louisiana ≥65 years with ESBC. Further understanding of factors leading to the decision for mastectomy in this age group is needed.

Inference on moderation effect with third-variable effect analysis - application to explore the trend of racial disparity in oncotype dx test for breast cancer treatment.

Third variable effect refers to the effect from a third variable that explains an observed relationship between an exposure and an outcome. Depending on whether there is causal relationship, typically, a third variable takes the format of a mediator or a confounder. A moderation effect is a special case of the third-variable effect, where the moderator and other variables have an interactive effect on the outcome. In this paper, we extend the R package 'mma' for moderation analysis so that third-variable effects can be reported at different levels of the moderator. The proposed moderation analysis use tree-structured models to automatically detect moderation effects and can handle both categorical and numerical moderators. We propose algorithms and graphical methods for making inference on moderation effects and illustrate the method under different scenarios of moderation effects. Finally, we apply the proposed method to explore the trend of racial disparities in the use of Oncotype DX recurrence tests among breast cancer patients. We found that the unexplained racial differences in using the tests have decreased from 2010 to 2015.

A WeChat-based smoking cessation intervention for Chinese smokers: a feasibility study.

WeChat is the largest social media platform in China, yet few WeChat-based smoking cessation interventions have been investigated to date. The objective of this study was to develop and test the feasibility of a WeChat-based smoking cessation intervention for smokers in China. Participants were recruited using WeChat and were then randomized into one of three groups: the Standard Group, the Enhanced Group, and the wait-list Control Group. Feasibility indicators including program reach, recruitment rate, recruitment efficiency, cost per person, attrition rate, intervention message exposure, group discussion utilization rate, intervention message engagement, satisfaction, and the likelihood of recommending to others were measured with assessed. Analyses included Chi-square and Fisher exact test, as well as analysis of variance test. A responsive participant is defined as a participant that responded to a certain assessment. A total of 1,132 individuals connected with ("friended") our project on WeChat between July 1 and August 5, 2019. Of these, 403 were eligible to participate, consented, and completed the baseline assessment. As a result, 136, 135, and 132 smokers were randomly assigned to the Standard Group, the Enhanced Group, and the Control Group, respectively. The total program recruitment rate was 35.6% and the attrition rate was 46.4%. The program cost was $0.85 per person. All responsive participants read at least one message during the intervention and engaged with intervention messages 56.8% of the time. Most responsive participants reported being very or somewhat satisfied, highly or somewhat engaged, and were willing to recommend our program to others. This study demonstrated the feasibility of a smoking cessation interventions using WeChat. The program could be expanded to deliver smoking cessation interventions to a large population of smokers.

A WeChat-based smoking cessation intervention for Chinese smokers: A pilot study.

Background: China is the largest tobacco producer and has the highest number of tobacco consumers in the world. Extensive research has demonstrated the utility of social media for smoking cessation. WeChat is the most commonly used social media platform in China, but has not yet been utilized for smoking cessation interventions. The objectives of this study are (1) to evaluate the efficacy of a WeChat-based smoking cessation intervention; and (2) to examine a possible additive effect of integrating oral health and smoking-related information into a tailored, Transtheoretical Model (TTM) guided smoking cessation intervention. Methods: Eligible adults were recruited through WeChat from July 1 to August 6, 2019, to participate in a 3-arm, single-blinded, randomized controlled trial. We enrolled and randomized 403 participants into three groups: the Standard Group, Enhanced Group, or a Waitlist-Control Group. Participants in the Standard Group received 20 smoking cessation-related messages for 2 weeks; participants in the Enhanced Group received this same protocol plus 6 oral health-related messages over an additional week. Participants in the Control Group received smoking cessation-related messages, after the post-intervention assessment. The primary outcome was TTM Stage of Change, and the secondary outcomes were 7-day Point Prevalence Abstinence (PPA), 24-h PPA, daily cigarette use, and nicotine dependence at 4 weeks follow-up post intervention, comparing intervention groups with the control group. The overall program attrition rate was 46%. Paired t-tests, McNemar tests, and linear and logistic regression were used to examine differences in smoking cessation outcomes within and between groups. Results: Participants in the Enhanced Group (ß = -1.28, 95%CI: -2.13, -0.44) and the Standard Group (ß = -1.13, 95%CI: -1.95, -0.30) reported larger changes in nicotine dependence scores, compared to participants in the Waitlist Group. No statistically significant differences were found between the Enhanced Group and the Standard Group. Discussion: This WeChat-based intervention was effective for smoking cessation overall. The addition of oral health information did not significantly improve the intervention.

Implementation of a WeChat-Based Smoking Cessation Program for Chinese Smokers.

Introduction: Although smoking prevalence has recently declined, the smoking prevalence in China remains high. Extensive research has demonstrated ways that social media can assist in quitting smoking. WeChat is the most commonly used social media platform in China but has not been used for smoking cessation. A process evaluation of a novel WeChat-based smoking cessation intervention was conducted to measure its efficacy of content delivery, participant satisfaction, engagement, and likelihood of recommendation to others. Methods: A three-week, three-arm, single-blind randomized control trial was established. WeChat was used to recruit 403 participants and to deliver intervention messages and process evaluation surveys to them. Recruitment advertisements were posted on an official WeChat account and were forwarded to WeChat Moments. Intervention messages were delivered once a day during weekdays, using the WeChat broadcasting messages function, with two messages being sent each time. Process evaluation surveys were organized using Wenjuanwang and were delivered via WeChat. Process assessments were conducted every Friday to assess intervention message receipt, satisfaction level, engagement level, and recommendation to others. The receipt of intervention messages was measured by a self-reported question indicating which messages were read each week. Satisfaction was measured by a five-item Likert scale survey. Engagement was measured by a one-item Likert scale survey. Recommendation to others was measured by one self-reported question. Results: Participants read an average of 4.76 (out of 10), 5.80 (out of 10), and 4.25 (out of 6) messages at week 1, week 2, and week 3, respectively. The second messages were less likely to be read compared to the first messages (52.3% vs. 61.6%, respectively). Moreover, within each single week, the number of participants who read the intervention messages gradually decreases over time. Picture-based intervention messages tended to be less likely to be read than video-based intervention messages. Total program satisfaction scores ranged between 5 and 25, and the overall scores for satisfaction for each week were 21.55, 22.27, and 22.76, respectively. No significant differences were found in all the satisfaction indicators between groups. More than 60% of participants reported being either highly engaged or somewhat engaged each week. In addition, most participants (93.0% at week 1, 95.8% at week 2, and 96.2% at week 3) reported that they were willing to recommend our program to others. Discussion: A WeChat-based smoking cessation intervention for Chinese smokers was implemented and evaluated. For future studies, one should consider sending messages of a higher importance as the first message of a given day. Smokers had a higher rate of reading intervention messages at the beginning part of each week, during which, relatively important messages should be prioritized. One might also consider alternating the topics and formats of the messages for a better engagement of the users in future studies.

Nickel and chromium ion release from coated and uncoated orthodontic archwires under different pH levels and exposure times.

OBJECTIVES: The purpose of this study was to determine and compare nickel and chromium ion release from traditional stainless steel and nickel titanium wires and newer esthetic archwires under different pH conditions, for different time intervals. METHODS: Ten pieces of 10-mm segments of five different orthodontic archwires were submerged in buffer solutions of pH 4.0, 5.5, and 7.0, for 4 and 13 weeks. The sample solutions were analyzed using ICP-MS. First, the results were analyzed by three-way ANOVA to determine any significant differences in metal concentration (ppb) between the different groups. Then, a post-hoc multiple pairwise comparison by Tukey's Studentized Range (HSD) Test was conducted to further compare the different materials and pH conditions. RESULTS: For nickel, uncoated NiTi had the highest nickel ion release (ppb), while AO Iconix had the lowest average nickel ion release, with a significant difference (p < 0.0001). The average nickel release increased with time and decreased with pH. For chromium, materials with uncoated stainless steel had the highest average chromium ion release, whereas AO Iconix had the lowest average chromium ion release, with a statistically significant difference (p < 0.0001). Chromium ion release increased with time and decreased with pH. CONCLUSIONS: There were significant differences in metal ion release between different pH conditions, materials, and time points. The metal ion release increased with increase in time and decrease in pH. Overall, the coated archwires showed less metal ion release than the uncoated wires.

Use of Geographic Information System Technology to Evaluate Health Disparities in Smoking Cessation Class Accessibility for Patients in Louisiana Public Hospitals.

Research has shown cigarette smoking is a major risk factors for many type of cancer or cancer prognosis. Tobacco related health disparities were addressed continually in cancer screening, diagnosis, treatment, prevention and control. The present study evaluated the health disparities in attendance of smoking cessation counseling classes for 4,826 patients scheduled to attend between 2005 and 2007. Of 3,781 (78.4%) patients with records to calculate the distance from their home domicile to counseling sites using Geographic Information System technology, 1,435 (38%) of smokers who attended counseling had shorter travel distances to counseling sites (11.6 miles, SD = 11.29) compared to non-attendees (13.4 miles, SD = 16.72). When the travel distance was >20 miles, the estimated odds of attending decreased with greater travel distance. Smokers who actually attended were more likely to be older, female, White, living in urban areas, and receiving free healthcare. After controlling for other socio-demographic factors, shorter distances were associated with greater class attendance, and individuals more likely to attend included those that lived closer to the counseling site and in urban settings, were female, White, commercially insured, and older than their counterparts. These findings have the potential to provide important insights for reducing health disparities for cancer prevention and control, and to improve shared decision making between providers and smokers.

Urban and Rural Disparities in a WeChat-Based Smoking Cessation Intervention among Chinese Smokers.

INTRODUCTION: Tobacco use, which is directly responsible for 10% of total deaths per year globally, remains consistently high, with approximately 20% of the population reporting regular consumption globally. Moreover, health disparities regarding tobacco consumption and smoking cessation are growing between rural and urban populations worldwide. Social media interventions for tobacco cessation may effectively reach both groups. The objective of this study was to evaluate the efficacy of a WeChat-delivered smoking cessation intervention among rural and urban Chinese smokers, and to assess moderating variables that may contribute to differential intervention efficacy. METHODS: WeChat was used to recruit smokers into this intervention study between 1 July and 5 August 2019. Participants were randomized to one of three intervention schedules: participants in the Standard Group and the Enhanced Group received 20 smoking-related messages over 2 weeks, whereas participants in the Enhanced Group received an extra 6 oral health-related messages for one week. Participants in the control group received 20 smoking-related messages after the post-intervention assessment. Participants completed questionnaires at baseline and at 4 weeks follow-up. Our primary outcome was smoking cessation stage of change and secondary outcome was 24-h point prevalence abstinence (PPA). Urban and rural areas were based on self-reported living areas. Chi-squared test, Fisher's exact test, ANOVA test, linear regression, and logistic regression were used for analysis. RESULTS: Overall, 403 participants completed the intervention (233 rural, 107 suburban, 63 urban). Compared to urban participants, rural participants were more likely to have progressed to a later stage of change (ß = 0.40, 95% CI: 0.13, 0.67) and to report higher 24-h PPA rates at follow-up (aOR = 3.23, 95% CI: 1.36, 7.68). After stratification by living area, the intervention effects in stage of change and 24-h PPA rate at follow-up were only found in the urban subgroup. DISCUSSION: Smokers who lived in rural areas reported better smoking cessation outcomes compared with urban smokers; however, the efficacy of a WeChat-based smoking cessation intervention was only found for participants living in an urban area. WeChat based smoking cessation interventions should be used to promote smoking cessation in urban, suburban, and rural areas.

Can Radiographic Tumor Volume of Oral Squamous Cell Carcinoma Help Predict Clinical and Pathological Tumor Features?

PURPOSE: Radiographic tumor volume (RTV) of oral squamous cell carcinoma (SCC) is seldom measured in practice. Aims of the study are to estimate RTV of SCC and to investigate its relationship with clinical and pathological stage, tumor margin status, recurrence, and need for chemo/radiation. METHODS: The design is a retrospective cohort study. The predictor variable is SCC RTV. The primary outcome variables are clinical and pathological tumor size. The secondary outcomes are margin status and postoperative chemo/radiation. Tumor dimensions were measured on preoperative maxillofacial or neck computer tomography images with contrast. Information on patient and tumor characteristics was obtained. Pearson correlation, t test, ANOVA and log rank test were used for statistical analysis. The significance level was set at .05. RESULTS: Thirty-six subjects aged 36 to 86 were included in the study. Positive association was found between clinical T stage and RTV (P = .0003) and between pathologic T stage and RTV (P = .002). Mean value of RTV was significantly higher in the group with positive margins (P = .0004). RTV was significantly higher in cancers requiring adjuvant chemo/radiation (P = .033). Mean RTV for patients with recurrence was 1.86 cm3 as compared to 1.29 cm3 for patients with no recurrence. Higher tumor volumes were more likely to be associated with recurrence. CONCLUSIONS: RTV is a variable that is readily available to head and neck surgeons. RTV is associated with clinical and pathological tumor sizes, margin status, need for adjuvant chemo/radiation and tumor recurrence.

Improvement in student-led debriefing analysis after simulation-based team training using a revised teamwork assessment tool.

BACKGROUND: Team debriefing is an important teamwork development intervention for improving team outputs in healthcare. Debriefing is a key component of experiential team training teamwork development interventions such as simulation-based training. Improving the quality of debriefing of healthcare teams, therefore, has multiple benefits. We investigated whether the quality of student-led debriefing improved using a shortened guide. METHODS: Senior medical students, nurse anesthesia students, and senior undergraduate nursing students participated in student operating room team training at a health sciences center in the southeastern United States. Student teams participated in a dual-scenario simulation-based training session with immediate after-action debriefings after each scenario. In 2018, student teams conducted the second debriefing using as a guide the teamwork assessment scale, an 11-item, 3-subscale, 6-point Likert-type instrument. In 2019, they used a shortened, revised, 5-item version of the teamwork assessment scale, the quick teamwork assessment scale. Trained observers rated the quality of the student-led debriefings using the Objective Structured Assessment of Debriefing, an 8-item, 5-point instrument. The Wilcoxon-Mann-Whitney test was used to compare the teamwork assessment scale-guided and the quick teamwork assessment scale-guided mean item debriefing scores. RESULTS: Two observers rated 3 student-led team debriefings using the teamwork assessment scales as a guide in 2018, and 6 such debriefings happened using the quick teamwork assessment scale as a guide in 2019. For each debriefing, observer scores were averaged for each Objective Structured Assessment of Debriefing item; these mean scores were then averaged with other mean scores for each year. The use of the quick teamwork assessment scale resulted in a statistically significant higher mean score for the Analysis Objective Structured Assessment of Debriefing item compared with the use of the teamwork assessment scale (4.92 [standard deviation 0.20] versus 3.83 [standard deviation 0.76], P = .023). CONCLUSION: The use of a shortened teamwork assessment instrument as a debriefing guide for student teams in student operating room team training was more effective in analysis of actions than the original, longer tool. Next steps include determining the efficacy of the quick teamwork assessment scale in an actual clinical setting.

Racial differences in the risk of second primary bladder cancer following radiation therapy among localized prostate cancer patients.

OBJECTIVES: To investigate the race-specific second primary bladder cancer (SPBC) risk following prostatic irradiation. METHODS: Louisiana residents who were diagnosed with localized prostate cancer (PCa) in 1996-2013 and received surgery or radiation were included. Patients were followed until SPBC diagnosis, death, or Dec. 2018. The exposure variable was type of treatment (radiation only vs. surgery only). The outcome was time from PCa diagnosis to SPBC diagnosis, stratified by race. Fine and Gray's competing risk model was applied with death as a competing event and adjustment of sociodemographic and tumor characteristics. We used 5 years and 10 years as lag time in the analyses. RESULTS: A total of 26,277 PCa patients with a median follow-up of 10.7 years were analyzed, including 18,598 white and 7679 black patients. About 42.9 % of whites and 45.7 % of blacks received radiation. SPBC counted for 1.84 % in the radiation group and 0.90 % in the surgery group among white patients and for 0.91 % and 0.58 %, respectively, among black patients. The adjusted subdistribution hazard ratio of SPBC was 1.80 (95 % CI: 1.30-2.48) for radiation recipients compared to surgery recipients among white patients; 1.93 (95 % CI: 1.36-2.74) if restricted to external beam radiation therapy (EBRT). The SPBC risk was not significantly different between irradiated and surgically treated among blacks. CONCLUSIONS: The SPBC risk is almost two-fold among white irradiated PCa patients compared to their counterparts treated surgically. Our findings highlight the need for enhanced surveillance for white PCa survivors receiving radiotherapy, especially those received EBRT.

Sulindac Modulates the Response of Proficient MMR Colorectal Cancer to Anti-PD-L1 Immunotherapy.

Immune-checkpoint inhibitor (ICI) therapy has been widely used to treat different human cancers, particularly advanced solid tumors. However, clinical studies have reported that ICI immunotherapy benefits only ∼15% of patients with colorectal cancer, specifically those with tumors characterized by microsatellite instability (MSI), a molecular marker of defective DNA mismatch repair (dMMR). For the majority of patients with colorectal cancer who carry proficient MMR (pMMR), ICIs have shown little clinical benefit. In this study, we examined the efficacy of sulindac to enhance the response of pMMR colorectal cancer to anti-PD-L1 immunotherapy. We utilized a CT26 syngeneic mouse tumor model to compare the inhibitory effects of PD-L1 antibody (Ab), sulindac, and their combination on pMMR colorectal cancer tumor growth. We found that mice treated with combination therapy showed a significant reduction in tumor volume, along with increased infiltration of CD8+ T lymphocytes in the tumor tissues. We also demonstrated that sulindac could downregulate PD-L1 by blocking NF-κB signaling, which in turn led to a decrease in exosomal PD-L1. Notably, PD-L1 Ab can be bound and consumed by exosomal PD-L1 in the blood circulation. Therefore, in combination therapy, sulindac downregulating PD-L1 leads to increased availability of PD-L1 Ab, which potentially improves the overall efficacy of anti-PD-L1 therapy. We also show that low-dose sulindac does not appear to have a systemic inhibitory effect on prostaglandin E2 (PGE2). In conclusion, our findings provide unique insights into the mechanism of action and efficacy for sulindac as an immunomodulatory agent in combination with anti-PD-L1 therapy for the treatment of pMMR colorectal cancer.

Multilevel mediation analysis on time-to-event outcomes: Exploring racial/ethnic disparities in breast cancer survival in California.

Background: Third-variable effect refers to the effect from a third-variable that explains an observed relationship between an exposure and an outcome. Depending on whether there is a causal relationship from the exposure to the third variable, the third-variable is called a mediator or a confounder. The multilevel mediation analysis is used to differentiate third-variable effects from data of hierarchical structures. Data Collection and Analysis: We developed a multilevel mediation analysis method to deal with time-to-event outcomes and implemented the method in the mlma R package. With the method, third-variable effects from different levels of data can be estimated. The method uses multilevel additive models that allow for transformations of variables to take into account potential nonlinear relationships among variables in the mediation analysis. We apply the proposed method to explore the racial/ethnic disparities in survival among patients diagnosed with breast cancer in California between 2006 and 2017, using both individual risk factors and census tract level environmental factors. The individual risk factors are collected by cancer registries and the census tract level factors are collected by the Public Health Alliance of Southern California in partnership with the Virginia Commonwealth University's Center on Society and Health. The National Cancer Institute work group linked variables at the census tract level with each patient and performed the analysis for this study. Results: We found that the racial disparity in survival were mostly explained at the census tract level and partially explained at the individual level. The associations among variables were depicted. Conclusion: The multilevel mediation analysis method can be used to differentiate mediation/confounding effects for factors originated from different levels. The method is implemented in the R package mlma.