Acute gastrointestinal graft-versus-host disease in pediatric patients: serum albumin on day 5 from initiation of therapy correlates with nonrelapse mortality and overall survival.

The aim of the present study was to identify factors associated with the risk of development of gastrointestinal acute graft-versus-host disease (GI-aGVHD), as well as to evaluate the impact of various baseline parameters on response to treatment, nonrelapse mortality (NRM), and overall survival (OS) in pediatric patients with GI-aGVHD after allogeneic hematopoietic stem cell transplantation (allo-SCT). We retrospectively analyzed 300 pediatric patients who underwent allo-SCT from HLA-matched related or volunteer unrelated donors in our institution. GI tract involvement was observed in 46 out of 133 patients with aGVHD grade II-IV. Severe aGVHD (grade III-IV) was more frequently observed among patients with GI-aGVHD in comparison with patients without GI involvement (P < .001). Treatment with steroids resulted in durable responses in 22/46 patients; 14 additional patients responded to salvage therapy, whereas 10 were refractory to all treatments administered. Using Cox regression analysis, we observed that serum albumin level ≥ 3 mg/dL on day 5 after the initiation of therapy with steroids was statistically significantly associated with decreased hazard of NRM and improved OS (P = .021 and P = .026, respectively). In our study, serum albumin level, early (+ day 5) after the onset of steroids in patients with GI-aGVHD, was a predictor of treatment outcome. Prospective randomized trials need to be performed to verify the predictive significance of serum albumin and the need for early intensification of immunosuppressive treatment.

Associating ridesourcing with road safety outcomes: Insights from Austin, Texas.

Improving road safety and setting targets for reducing traffic-related crashes and deaths are highlighted as part of the United Nations sustainable development goals and worldwide vision zero efforts. The advent of transportation network companies and ridesourcing expands mobility options in cities and may impact road safety outcomes. We analyze the effects of ridesourcing use on road crashes, injuries, fatalities, and driving while intoxicated (DWI) offenses in Travis County, Texas. Our approach leverages real-time ridesourcing volume to explain variation in road safety outcomes. Spatial panel data models with fixed-effects are deployed to examine whether the use of ridesourcing is significantly associated with road crashes and other safety metrics. Our results suggest that for a 10% increase in ridesourcing trips, we expect a 0.12% decrease in road crashes, a 0.25% decrease in road injuries, and a 0.36% decrease in DWI offenses in Travis County. On the other hand, ridesourcing use is not significantly associated with road fatalities. This study augments existing work because it moves beyond binary indicators of ridesourcing availability and analyzes crash and ridesourcing trips patterns within an urbanized area rather than their metropolitan-level variation. Contributions include developing a data-rich approach for assessing the impacts of ridesourcing use on the transportation system's safety, which may serve as a template for future analyses for other cities. Our findings provide feedback to policymakers by clarifying associations between ridesourcing use and traffic safety and uncover the potential to achieve safer mobility systems with transportation network companies.

U.S. active school travel in 2017: Prevalence and correlates.

Active transportation to school (ATS), denoting walking and biking, is crucial to promote physical activity for youth. This study uses data from the 2017 National Household Travel Survey (NHTS) to report on the most recent and nationally representative school transportation patterns. Binary logit modeling determines significant factors associated with school travel mode choices. Spatial differences on school mode choices across the US are explored. In 2017 9.6% of the students of 5-17 years old usually walked and 1.1% biked to school. For students who usually walk to school, 77.5% of their school trips were less than one mile and, among usual bikers to school, 82.8% of trips were less than two miles. Student rates of walking to school decreased as the distance to school increased and biking rates peaked when distance to school was between 0.5 and 1 miles. When distance to school was <0.5 miles, walking was the most common mode for urban and rural regions. When the trip was shorter than or equal to one mile, factors such child's school grade, household vehicles per driver, and household income were associated with the decision to walk or bike to school. Other demographic characteristics like race and gender were not significantly related to ATS. While comparison across NHTS years should be viewed with caution due to changes in survey methodology, the decline of ATS rates indicate that more effective and higher reaching efforts for local, regional, and national interventions should be prioritized.