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JAMA Network Open Jan 2023Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing...
IMPORTANCE
Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth.
OBJECTIVE
To estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery.
DESIGN, SETTING, AND PARTICIPANTS
An economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute-Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021.
MAIN OUTCOMES AND MEASURES
The main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract-level median hourly wages were used.
RESULTS
The study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile.
CONCLUSIONS AND RELEVANCE
In this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.
Topics: Humans; Female; COVID-19; Cost Savings; Pandemics; Telemedicine; Ambulatory Care; Neoplasms
PubMed: 36626174
DOI: 10.1001/jamanetworkopen.2022.50211 -
BMJ Open Sport & Exercise Medicine 2021This study aimed to investigate the impact of an ultramarathon (UM) with a distance of 100 miles on heart rate (HR) and heart rate variability (HRV).
AIMS
This study aimed to investigate the impact of an ultramarathon (UM) with a distance of 100 miles on heart rate (HR) and heart rate variability (HRV).
METHODS
28 runners (25 men and 3 women) underwent 24-hour Holter ECG monitoring 1 week before the UM, immediately after the UM and after a week of recovery. The influence of age, body mass index (BMI), HR and HRV on the run time and recovery was investigated.
RESULTS
A rise in the baseline HR (18.98%) immediately after the run accompanied by a significant drop in the SD of all normal RR intervals (7.12%) 1 week after. Except for the runners' age, BMI, HR and HRV showed no influence on the competition time. Full return of HRV to the athletes' baseline did not occur within 1 week. There were no significant differences between finishers and non-finishers in the analysed parameters.
CONCLUSION
The present results show that a 100-mile run leads to an increase in sympathetic activity and thus to an increase in HR and a decrease in HRV. Also, HRV might be a suitable parameter to evaluate the state of recovery after a 100-mile run but does not help to quantify the status of recovery, as the damage to the tendomuscular system primarily characterises this after completing a UM.
PubMed: 34046186
DOI: 10.1136/bmjsem-2020-001005 -
Ecology and Evolution Nov 2021The ecotype population of goats () was created by long-term artificial selection and natural adaptation. Mile red-bone goat is an indigenous breed with visible red...
The ecotype population of goats () was created by long-term artificial selection and natural adaptation. Mile red-bone goat is an indigenous breed with visible red bones, and its special bone structure has received extensive attention. This study aimed to identify genetic variants and candidate genes associated with specific bone phenotypes using next-generation sequencing technology (NGS). The results revealed that 31,828,206 single nucleotide polymorphisms (SNPs) were obtained from 72 goats (20 Mile red-bone goats and 52 common goats) by NGS. A total of 100 candidate genes were identified on the basis top 1% window interaction from nucleotide diversity (), ratio ( / ), and pairwise fixation index ( ). Exactly 77 known signaling pathways were enriched. Specifically, three coding genes (, , and ) were annotated in the vitamin metabolism signaling pathways, and was annotated to the osteoclast (OC) differentiation pathway. Furthermore, 5862 reliable copy number variations (CNVs) were obtained, and 14 and 24 genes were annotated with the top 1‰ CNV based on (>0.490) and (>0.527), respectively. Several pathways related to bone development and metabolism of exogenous substances in vivo, including calcium signaling pathway, OC differentiation, and glycerophospholipid metabolism, were annotated. Specifically, six genes from 19 candidate CNVs, which were obtained by interaction of the top 1‰ CNVs with and , were annotated to mucin-type O-glycan biosynthesis and metabolic pathways. Briefly, the results implied that pseudopurpurin and specific genetic variants work together to contribute to the red-bone color and specific bone structure of Mile red-bone goat. This study is helpful to understanding the genetic basis of the unique bone phenotype of Mile red-bone goats.
PubMed: 34765142
DOI: 10.1002/ece3.8165 -
Journal of Global Oncology Sep 2018The growing cancer epidemic is a major public health challenge globally but especially in low- and middle-income countries where patients often have to make long and... (Review)
Review
The growing cancer epidemic is a major public health challenge globally but especially in low- and middle-income countries where patients often have to make long and complex journeys to receive care. Extending cancer prevention, diagnosis, and treatment to low- and middle-income countries through innovative solutions such as digital health systems is an urgent health priority. We contend that such digital systems will achieve success and scale only when existing gaps in cancer care and control policies and practices are addressed to strengthen health systems and improve outcomes. We call for concerted action to focus on the effective implementation of cancer care and control policies and practice in last-mile settings to improve pathways to care for people with and at risk for cancer.
Topics: Delivery of Health Care; Humans; Neoplasms; Public Health; Quality Improvement; Quality of Health Care; Telemedicine
PubMed: 30241157
DOI: 10.1200/JGO.2016.007179 -
OncoTargets and Therapy 2018Minimally invasive esophagectomy is increasingly performed for esophageal or gastroesophageal junctional cancer, with advantages of improved perioperative outcomes in... (Review)
Review
Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis.
PURPOSE
Minimally invasive esophagectomy is increasingly performed for esophageal or gastroesophageal junctional cancer, with advantages of improved perioperative outcomes in comparison with open esophagectomy. McKeown and Ivor Lewis are widely used procedures of minimally invasive esophagectomy, and there have been controversies on which one is preferred for patients with resectable esophageal or junctional cancer.
PATIENTS AND METHODS
This review was registered at the International Prospective Register of Systematic Reviews (number CRD42017075989). Studies in PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were thoroughly investigated. Eligible studies included prospective and retrospective studies evaluating short-term outcomes of minimally invasive McKeown esophagectomy (MIME) vs minimally invasive Ivor Lewis esophagectomy (MILE) in patients with resectable esophageal or junctional tumors. Main parameters included anastomotic leak and 30-day/in-hospital mortality. Overall incidence rates (ORs)/weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated by employing random-effects models.
RESULTS
Fourteen studies containing 3,468 cases were included in this meta-analysis. Age, male sex, and American Joint Committee on Cancer (AJCC) stage between the 2 groups were not statistically different. MIME led to more blood loss, longer operating time, and longer hospital stay than MILE. MIME was associated with higher incidence of pulmonary complications (OR =1.96, 95% CI =1.28-3.00) as well as total anastomotic leak (OR =2.55, 95% CI =1.40-4.63), stricture (OR =2.07, 95% CI =1.05-4.07), and vocal cord injury/palsy (OR =5.62, 95% CI =3.46-9.14). In addition, the differences of R0 resection rate, number of lymph modes retrieved, blood transfusion rate, length of intensive care unit stay, incidence of cardiac arrhythmia, and Chyle leak between MIME and MILE were not statistically significant. Notably, incidence of severe anastomotic leak (OR =1.28, 95% CI =0.73-2.24) and 30-day/in-hospital mortality (OR =1.76, 95% CI =0.92-3.36) as well as 90-day mortality (OR =2.22, 95% CI =0.71-6.98) between the 2 procedures were also not significantly different.
CONCLUSION
This study suggests that MIME and MILE are comparable with respect to clinical safety. MILE may be a better option when oncologically and clinically suitable. MIME is still a safe alternative procedure when clinically indicated. However, this evidence is at risk for bias; randomized controlled trials are needed to validate or correct our results.
PubMed: 30275710
DOI: 10.2147/OTT.S169488 -
International Journal of Obesity (2005) Apr 2020The Daily Mile is designed to increase physical activity levels with children running or walking around school grounds for 15-min daily. It has been adopted by schools... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The Daily Mile is designed to increase physical activity levels with children running or walking around school grounds for 15-min daily. It has been adopted by schools worldwide and endorsed as a solution to tackle obesity, despite no robust evidence of its benefits. We conducted a cluster randomised controlled trial to determine its clinical and cost-effectiveness.
METHODS
Forty schools were randomly assigned (1:1) to either the Daily Mile intervention or control group in which only the usual school health and wellbeing activities were implemented. The primary outcome was BMI z-score (BMIz) at 12 months follow-up from baseline, with planned subgroup analysis to examine differential effects. Primary economic analysis outcome was incremental cost per Quality-Adjusted-Life-Year (QALY) gained.
RESULTS
Using a constrained randomisation approach, balanced on school size, baseline BMIz and proportion of pupils eligible for free school meals, 20 schools were allocated to intervention (n = 1,153 participants) and 20 to control (n = 1,127); 3 schools withdrew (2 intervention, 1 control). At 12 months, BMIz data were available for 18 intervention schools (n = 850) and 19 control schools (n = 820 participants). Using intention-to-treat analysis the adjusted mean difference (MD) in BMIz (intervention - control) was -0.036 (95% CI: -0.085 to 0.013, p = 0.146). Pre-specified subgroup analysis showed a significant interaction with sex (p = 0.001) suggesting a moderate size benefit of The Daily Mile in girls (MD -0.097, 95% CI -0.156 to -0.037). This was consistent with the exploratory economic results that showed The Daily Mile to be highly cost-effective in girls (£2,492 per QALY), but not in boys, and overall to have a 76% chance of cost-effectiveness for the whole sample, at the commonly applied UK threshold of £20,000 per QALY.
CONCLUSIONS
Overall the Daily Mile had a small but non-significant effect on BMIz, however, it had a greater effect in girls suggesting that it might be considered as a cost-effective component of a system-wide approach to childhood obesity prevention.
Topics: Body Weight; Child; Child, Preschool; Cost-Benefit Analysis; Female; Health Promotion; Humans; Life Style; Male; Quality-Adjusted Life Years; Walking
PubMed: 31988481
DOI: 10.1038/s41366-019-0511-0 -
BMC Health Services Research Dec 2022To assess whether decreasing distance between hospitals was associated with the number of shared patients (patients with an admission to one hospital and a readmission...
BACKGROUND
To assess whether decreasing distance between hospitals was associated with the number of shared patients (patients with an admission to one hospital and a readmission to another).
METHODS
Data were from the Healthcare Cost and Utilization Project's State Inpatient Databases (Florida, Georgia, Maryland, Utah [2017], New York, Vermont [2016]) and the American Hospital Association Annual Survey (2016 & 2017). This was a cross-sectional analysis of patients who had an index admission and subsequent readmission at different hospitals within the same year. We used unadjusted and adjusted linear regression to evaluate the association between the number of shared patients and the distance between admission-readmission hospital pairs.
RESULTS
There were 691 hospitals in the sample (247 in Florida, 151 in Georgia, 50 in Maryland, 172 in New York, 58 in Utah, and 13 in Vermont), accounting for a total of 596,772 admission-readmission pairs. 32.6% of the admission-readmission pairs were shared between two hospitals. On average, a one-mile decrease in distance between two hospitals was associated with of 3.05 (95% CI, 3.02, 3.07) more shared admissions. However, variability between states was wide, with Utah having 0.37 (95% CI 0.35, 0.39) more shared admissions between hospitals per one-mile shorter distance, and Maryland having 4.98 (95% CI 4.87, 5.08) more.
CONCLUSIONS
We found that proximity between hospitals is associated with higher volumes of shared admissions.
Topics: United States; Humans; Patient Readmission; Cross-Sectional Studies; Hospitals; Hospitalization; Inpatients; Retrospective Studies
PubMed: 36522778
DOI: 10.1186/s12913-022-08931-1 -
International Journal of Environmental... Nov 2021The aims of the current study were to compare the pacing patterns of all-time 800 m, 1500 m and mile running world records (WRs) and to determine whether differences...
The aims of the current study were to compare the pacing patterns of all-time 800 m, 1500 m and mile running world records (WRs) and to determine whether differences exist between sexes, and if 800 m and 1500 m WRs were broken during championship or meet races. Overall and lap times for men and women's 800 m, 1500 m, and mile WRs from World Athletics were collected when available and subsequently compared. A fast initial 200 m segment and a decrease in speed throughout was found during 800 m WRs. Accordingly, the first 200 m and 400 m were faster than the last 200 m and 400 m, respectively ( < 0.001, 0.77 ≤ ES ≤ 1.86). The first 400 m and 409 m for 1500 m and mile WRs, respectively, were faster than the second lap ( < 0.001, 0.74 ≤ ES ≤ 1.46). The third 400 m lap was slower than the last 300 m lap and 400 m lap for 1500 m and mile WRs, respectively ( < 0.001, 0.48 ≤ ES ≤ 1.09). No relevant sex-based differences in pacing strategy were found in any event. However, the first 409 m lap was faster than the last 400 m lap for men but not for women during mile WRs. Women achieved a greater % of WRs than men during championships (80% vs. 45.83% in the 800 m, and 63.63% vs. 31.58% in the 1500 m, respectively). In conclusion, positive, reverse J-shaped and U-shaped pacing profiles were used to break 800 m, men's mile and 1500 m, and women's mile WRs, respectively. WRs are more prone to be broken during championships by women than men.
Topics: Athletic Performance; Competitive Behavior; Female; Humans; Male; Running; Time
PubMed: 34886317
DOI: 10.3390/ijerph182312589 -
PloS One 2018Emerging evidence indicates that proximity to unconventional oil and gas development (UOGD) is associated with health outcomes. There is intense debate about "How close...
Emerging evidence indicates that proximity to unconventional oil and gas development (UOGD) is associated with health outcomes. There is intense debate about "How close is too close?" for maintaining public health and safety. The goal of this Delphi study was to elicit expert consensus on appropriate setback distances for UOGD from human activity. Three rounds were used to identify and seek consensus on recommended setback distances. The 18 panelists were health care providers, public health practitioners, environmental advocates, and researchers/scientists. Consensus was defined as agreement of ≥70% of panelists. Content analysis of responses to Round 1 questions revealed four categories: recommend setback distances; do not recommend setback distances; recommend additional setback distances for vulnerable populations; do not recommend additional setback distances for vulnerable populations. In Round 2, panelists indicated their level of agreement with the statements in each category using a five-point Likert scale. Based on emerging consensus, statements within each category were collapsed into seven statements for Round 3: recommend set back distances of <¼ mile; ¼-½ mile; 1-1 ¼ mile; and ≥ 2 mile; not feasible to recommend setback distances; recommend additional setbacks for vulnerable groups; not feasible to recommend additional setbacks for vulnerable groups. The panel reached consensus that setbacks of < ¼ mile should not be recommended and additional setbacks for vulnerable populations should be recommended. The panel did not reach consensus on recommendations for setbacks between ¼ and 2 miles. The results suggest that if setbacks are used the distances should be greater than ¼ of a mile from human activity, and that additional setbacks should be used for settings where vulnerable groups are found, including schools, daycare centers, and hospitals. The lack of consensus on setback distances between 1/4 and 2 miles reflects the limited health and exposure studies and need to better define exposures and track health.
Topics: Consensus; Delphi Technique; Health Personnel; Humans; Oil and Gas Industry; Public Health; Research Personnel; Surveys and Questionnaires
PubMed: 30114206
DOI: 10.1371/journal.pone.0202462 -
Water Research Aug 2022Natural sediment flocs are fragile and highly heterogeneous aggregates of biogenic and minerogenic material typically with high porosity and low density. In aquatic...
Natural sediment flocs are fragile and highly heterogeneous aggregates of biogenic and minerogenic material typically with high porosity and low density. In aquatic environments dominated by fine, cohesive or mixed sediments they can dominate suspended sediment flux. Consequently, monitoring and modelling the behaviour, transport and distribution of flocs is very important for many aquatic industries, maintenance of waterways and conservation and management of aquatic waterbodies. Mathematical models that predict the behaviour of flocs rely on the accurate assessments of the size, shape, density, porosity and fractal dimension of flocs. These inherently 3-dimensional (3D) characteristics are typically derived from 2-dimensional (2D) data, largely due to the challenges associated with sampling, capturing, imaging and quantifying these fragile aggregates. We have developed new volumetric microscopy techniques which can quantify 3D internal and external structures and characteristics of sediment flocs. Here, these techniques were applied to quantify the 3D size (volume), shape and fractal dimension of natural and artificial sediment flocs and compare them to standard 2D approaches. Our study demonstrates that 2D approaches are under-estimating shape complexity and over-estimating the size and mass settling flux of flocs by up to two orders of magnitude, and the discrepancy between 2D and 3D is most marked for natural, organic rich macroflocs. Our study has significant implications for estimations of sediment flux at local to global scales within in aquatic environments. These new data and approaches offer the potential to improve the current parameterisation of sediment transport models and to improve the accuracy of current field-monitoring techniques.
Topics: Flocculation; Fractals; Geologic Sediments; Models, Theoretical; Porosity
PubMed: 35914497
DOI: 10.1016/j.watres.2022.118835