Survival of Colonizing Wolves in the Northern Rocky Mountains of the United States, 1982–2004

Abstract: After roughly a 60-year absence, wolves (Canis lupus) immigrated (1979) and were reintroduced (1995-1996) into the northern Rocky Mountains (NRM), USA, where wolves are protected under the Endangered Species Act. The wolf recovery goal is to restore an equitably distributed metapopulation of ≥30 breeding pairs and 300 wolves in Montana, Idaho, and Wyoming, while minimizing damage to livestock; ultimately, the objective is to establish state-managed conservation programs for wolf populations in NRM. Previously, wolves were eradicated from the NRM because of excessive human killing. We used Andersen–Gill hazard models to assess biological, habitat, and anthropogenic factors contributing to current wolf mortality risk and whether federal protection was adequate to provide acceptably low hazards. We radiocollared 711 wolves in Idaho, Montana, and Wyoming (e.g., NRM region of the United States) from 1982 to 2004 and recorded 363 mortalities. Overall, annual survival rate of wolves in the recovery areas was 0.750 (95% CI = 0.728-0.772), which is generally considered adequate for wolf population sustainability and thereby allowed the NRM wolf population to increase. Contrary to our prediction, wolf mortality risk was higher in the northwest Montana (NWMT) recovery area, likely due to less abundant public land being secure wolf habitat compared to other recovery areas. In contrast, lower hazards in the Greater Yellowstone Area (GYA) and central Idaho (CID) likely were due to larger core areas that offered stronger wolf protection. We also found that wolves collared for damage management purposes (targeted sample) had substantially lower survival than those collared for monitoring purposes (representative sample) because most mortality was due to human factors (e.g., illegal take, control). This difference in survival underscores the importance of human-caused mortality in this recovering NRM population. Other factors contributing to increased mortality risk were pup and yearling age class, or dispersing status, which was related to younger age cohorts. When we included habitat variables in our analysis, we found that wolves having abundant agricultural and private land as well as livestock in their territory had higher mortality risk. Wolf survival was higher in areas with increased wolf density, implying that secure core habitat, particularly in GYA and CID, is important for wolf protection. We failed to detect changes in wolf hazards according to either gender or season. Maintaining wolves in NWMT will require greater attention to human harvest, conflict resolution, and illegal mortality than in either CID or GYA; however, if human access increases in the future in either of the latter 2 areas hazards to wolves also may increase. Indeed, because overall suitable habitat is more fragmented and the NRM has higher human access than many places where wolves roam freely and are subject to harvest (e.g., Canada and AK), monitoring of wolf vital rates, along with concomitant conservation and management strategies directed at wolves, their habitat, and humans, will be important for ensuring long-term viability of wolves in the region.     

Surgical resection as a predictor of cancer-specific survival by stage at diagnosis and cancer type,United States, 2006–2015

BackgroundWhen solid tumors are amenable to definitive resection, clinical outcomes are generally superior to when those tumors are inoperable. However, the population-level cancer survival benefit of eligibility for surgery by cancer stage has not yet been quantified.MethodsUsing Surveillance, Epidemiology and End Results data allowing us to identify patients who were deemed eligible for and received surgical resection, we examined the stage-specific association of surgical resection with 12-year cancer-specific survival. The 12-year endpoint was selected to maximize follow-up time and thereby minimize the influence of lead time bias.ResultsAcross a variety of solid tumor types, earlier stage at diagnosis allowed for surgical intervention at a much higher rate than later-stage diagnosis. At every stage, surgical intervention was associated with a substantially higher rate of 12-year cancer-specific survival, with absolute differences of up to 51% for stage I, 51% for stage II, and 44% for stage III cancer, and stage-specific mortality relative risks of 3.6, 2.4, and 1.7, respectively.ConclusionsDiagnosis of solid cancers in early stages often enables surgical resection, which reduces the risk of death from cancer. Receipt of surgical resection is an informative endpoint that is strongly associated with long-term cancer-specific survival at every stage.     

Incidence patterns and trends of malignant gonadal and extragonadal germ cell tumors in Germany, 1998–2008

BackgroundMalignant gonadal (GGCT) and extragonal germ cell tumors [GCT (EGCT)] are thought to originate from primordial germ cells. In contrast to well reported population-based data of GGCTs in males, analyses of GGCTs in females and EGCTs in both sexes remain limited.MethodsIn a pooling project of nine population-based cancer registries in Germany for the years 1998–2008, 16,883 malignant GCTs and their topographical sites were identified using ICD-O morphology and topography for persons aged 15 years and older. We estimated age-specific and age-standardized incidence rates.ResultsAmong males, the incidence of testicular GCTs increased over time. In contrast, there was no increase in the incidence of EGCTs. Among females, rates of ovarian GCTs were stable, while rates of EGCTs declined over time. The most frequent extragonadal sites were mediastinum among males and placenta among females.ConclusionsOur results underline different incidence trends and distinct age-specific incidence patterns of malignant GGCTs and EGCTs, as reported recently by several population-based registries. The differences suggest that GGCT and EGCT may have different etiologies.     

Influenza Illness and Hospitalizations Averted by Influenza Vaccination in the United States, 2005–2011

Context

The goal of influenza vaccination programs is to reduce influenza-associated disease outcomes. Therefore, estimating the reduced burden of influenza as a result of vaccination over time and by age group would allow for a clear understanding of the value of influenza vaccines in the US, and of areas where improvements could lead to greatest benefits.

Objective

To estimate the direct effect of influenza vaccination in the US in terms of averted number of cases, medically-attended cases, and hospitalizations over six recent influenza seasons.

Design

Using existing surveillance data, we present a method for assessing the impact of influenza vaccination where impact is defined as either the number of averted outcomes or as the prevented disease fraction (the number of cases estimated to have been averted relative to the number of cases that would have occurred in the absence of vaccination).

Results

We estimated that during our 6-year study period, the number of influenza illnesses averted by vaccination ranged from a low of approximately 1.1 million (95% confidence interval (CI) 0.6–1.7 million) during the 2006–2007 season to a high of 5 million (CI 2.9–8.6 million) during the 2010–2011 season while the number of averted hospitalizations ranged from a low of 7,700 (CI 3,700–14,100) in 2009–2010 to a high of 40,400 (CI 20,800–73,000) in 2010–2011. Prevented fractions varied across age groups and over time. The highest prevented fraction in the study period was observed in 2010–2011, reflecting the post-pandemic expansion of vaccination coverage.

Conclusions

Influenza vaccination programs in the US produce a substantial health benefit in terms of averted cases, clinic visits and hospitalizations. Our results underscore the potential for additional disease prevention through increased vaccination coverage, particularly among nonelderly adults, and increased vaccine effectiveness, particularly among the elderly.     

Patterns and trends in the incidence of paediatric and adult germ cell tumours in Australia, 1982–2011

PurposeGerm cell tumour (GCT) aetiology is uncertain and comprehensive epidemiological studies of GCT incidence are few.MethodsNationwide data on all malignant GCTs notified to Australian population-based cancer registries during 1982–2011 were obtained. Age- and sex-specific, and World age-standardised incidence rates were calculated for paediatric (0–14) and adult (15+) cases using the latest WHO subtype classification scheme. Temporal trends were examined using Joinpoint regression.ResultsThere were 17,279 GCTs (552 paediatric, 16,727 adult). Age-specific incidence in males (all histologies combined) was bimodal, with peaks during infancy for most sites, and second, larger, peaks during young adulthood. Incidence of ovarian tumours peaked at age 15–19. Around half of paediatric tumours were extragonadal, whereas adult tumours were mostly gonadal. Yolk sac tumours and teratomas predominated in infants, whereas germinomas became more frequent towards adulthood. Increasing incidence trends for some adult gonadal tumours have stabilised; the trend for male extragonadal tumours is also declining.ConclusionBroad similarities in the shape of age-specific incidence curves, particularly for gonadal, central nervous system, and mediastinal tumours provide epidemiological support for commonalities in aetiology among clinically disparate GCT subtypes. Differences in peak ages reflect underlying subtype-specific biological differences. Declining incidence trends for some adult gonadal tumours accords with the global transition in GCT incidence, and supports the possibility of a reduction in prevalence of shared aetiological exposures.     

β-Lactam Resistance in Salmonella Strains Isolated from Retail Meats in the United States by the National Antimicrobial Resistance Monitoring System between 2002 and 2006

Ampicillin-resistant (Amp^r) Salmonella enterica isolates (n = 344) representing 32 serotypes isolated from retail meats from 2002 to 2006 were tested for susceptibility to 21 other antimicrobial agents and screened for the presence of five beta-lactamase gene families (bla_CMY, bla_TEM, bla_SHV, bla_OXA, and bla_CTX-M) and class 1 integrons. Among the Amp^r isolates, 66.9% were resistant to five or more antimicrobials and 4.9% were resistant to 10 or more antimicrobials. Coresistance to other β-lactams was noted for amoxicillin-clavulanic acid (55.5%), ceftiofur (50%), cefoxitin (50%), and ceftazidime (24.7%), whereas less than 5% of isolates were resistant to piperacillin-tazobactam (4.9%), cefotaxime (3.5%), ceftriaxone (2%), and aztreonam (1.2%). All isolates were susceptible to cefepime, imipenem, and cefquinome. No Salmonella producing extended-spectrum beta-lactamases was found in this study. Approximately 7% of the isolates displayed a typical multidrug-resistant (MDR)-AmpC phenotype, with resistance to ampicillin, chloramphenicol, streptomycin, sulfonamide, tetracycline, plus resistance to amoxicillin-clavulanic acid, cefoxitin, and ceftiofur and with decreased susceptibility to ceftriaxone (MIC ≥ 4 μg/ml). Pulsed-field gel electrophoresis results showed that several MDR clones were geographically dispersed in different types of meats throughout the five sampling years. Additionally, 50% of the isolates contained bla_CMY, 47% carried bla_TEM-1, and 2.6% carried both genes. Only 15% of the isolates harbored class I integrons carrying various combinations of aadA, aadB, and dfrA gene cassettes. The bla_CMY, bla_TEM, and class 1 integrons were transferable through conjugation and/or transformation. Our findings indicate that a varied spectrum of coresistance traits is present in Amp^r Salmonella strains in the meat supply of the United States, with a continued predominance of bla_CMY and bla_TEM genes in β-lactam-resistant isolates.Nontyphoid Salmonella enterica is one of the most important food-borne pathogens and represents a significant public health hazard worldwide. It is estimated that 1.4 million people in the United States are infected with non-Typhi Salmonella annually, resulting in 15,000 hospitalizations and more than 400 deaths (28). Salmonella infections in humans often result from the ingestion of contaminated foods, such as poultry, beef, pork, eggs, milk, seafood, and produce (10). Salmonellosis following direct contact with animals and dog treats has also been reported (3, 6, 7). Human salmonellosis usually results in a self-limiting diarrhea that does not require antimicrobial therapy. However, in severe cases of enteritis and systemic infections, fluoroquinolones and extended-spectrum cephalosporins such as ceftriaxone (AXO) are used as first-line therapeutics (12, 27).Multidrug-resistant (MDR) Salmonella strains have been detected in many serotypes, such as S. enterica serotype Typhimurium (9, 26), S. enterica serotype Agona, S. enterica serotype Anatum, S. enterica serotype Choleraesuis, S. enterica serotype Dublin, S. enterica serotype Heidelberg, S. enterica serotype Kentucky, S. enterica serotype Newport, S. enterica serotype Schwarzengrund, S. enterica serotype Senftenberg, and S. enterica serotype Uganda, among others (14, 33, 35) (http://internet-dev/cvm/2005NARMSExeRpt.htm). The most common MDR pattern, which first emerged in S. Typhimurium, has been a pattern of resistance to ampicillin (AMP), chloramphenicol (CHL), streptomycin (STR), sulfonamides, and tetracycline (TET) (ACSSuT). More recently, strains exhibiting the ACSSuT pattern also have acquired MDR plasmids carrying the bla_CMY gene and others (30) that can spread readily to different members of the Enterobacteriaceae. The strains demonstrate extensive resistances, which, in addition to the ACSSuT phenotype, may include resistance to amoxicillin-clavulanic acid (AUG), cefoxitin (FOX), and ceftiofur (TIO) and decreased susceptibility to AXO (MIC ≥ 4 μg/ml). TIO is a third-generation cephalosporin that was approved for use in animals in 1998. Tio^r Salmonella isolates often show resistance or decreased susceptibility to AXO (also a third-generation cephalosporin used to treat human infections). Some strains may also display resistance to gentamicin (GEN), kanamycin (KAN), and trimethoprim-sulfamethoxazole ([SMX] COT) as well as resistance to disinfectants and heavy metals. Resistance to third-generation cephalosporins in Salmonella strains is of interest because these are the drugs of choice for treating salmonellosis in children, where fluoroquinolones are contraindicated (13).To date, more than 340 beta-lactamases have been described (11). The most common genes, such as bla_TEM, bla_SHV, bla_CTX-M, bla_OXA, bla_PER, bla_PSE, and bla_CMY, have been detected in Salmonella, with the prevalence of these genes varying by region (32). Extended-spectrum beta-lactamases (ESBLs) are less prevalent in Salmonella strains than in other gram-negative bacteria such as Klebsiella, Escherichia coli, and Proteus. The ESBLs are β-lactamases capable of conferring bacterial resistance to the penicillins; to first-, second-, and third-generation cephalosporins; and to aztreonam (ATM) (but not to the cephamycins or carbapenems) by hydrolysis of these antibiotics, which are inhibited by β-lactamase inhibitors such as clavulanic acid (21). Most ESBL-carrying Salmonella strains have been reported in Latin America, the Western Pacific, and Europe (32), with only a few reports from North America. In the United States the first case was reported in 1994, when bla_CTX-5 was detected in an S. Typhimurium var. Copenhagen strain from an infant adopted from Russia (25). Additional ESBL Salmonella strains have been reported recently, one from a horse (bla_SHV-12) and another from a 3-month-old child (bla_CTX-M-5) (23, 25). Carbapenem resistance in Salmonella is also rare in the United States but has been detected in S. enterica serotype Cubana associated with a plasmid-mediated bla_KPC-2 gene (18). In contrast to the low prevalence of ESBL-carrying Salmonella strains in the United States, AmpC resistance mediated by bla_CMY has been emerging in both humans and food animals. The bla_CMY encodes a cephalomycinase that exhibits extended resistance to many beta-lactams, including first-, second-, and third-generation cephalosporins (36).The objectives of this study were to determine the genetic basis of beta-lactam resistance and to examine the extent of coresistance to other antimicrobials among 344 Amp^r Salmonella isolates obtained from retail meats. We screened for the presence of five beta-lactam resistance gene families (bla_CMY, bla_TEM, bla_SHV, bla_OXA, and bla_CTX-M) and the presence of class 1 integrons. The range of resistance phenotypes borne on plasmids was examined by filter mating and electroporation, and all isolates were characterized for genetic relatedness using pulsed-field gel electrophoresis (PFGE).     

Comparison of black–white disparities in preterm birth between Canada and the United States

Background:

A higher risk of preterm birth among black women than among white women is well established in the United States. We compared differences in preterm birth between non-Hispanic black and white women in Canada and the US, hypothesizing that disparities would be less extreme in Canada given the different historical experiences of black populations and Canada’s universal health care system.

Methods:

Using data on singleton live births in Canada and the US for 2004–2006, we estimated crude and adjusted risk ratios and risk differences in preterm birth (< 37 wk) and very preterm birth (< 32 wk) among non-Hispanic black versus non-Hispanic white women in each country. Adjusted models for the US were standardized to the covariate distribution of the Canadian cohort.

Results:

In Canada, 8.9% and 5.9% of infants born to black and white mothers, respectively, were preterm; the corresponding figures in the US were 12.7% and 8.0%. Crude risk ratios for preterm birth among black women relative to white women were 1.49 (95% confidence interval [CI] 1.32 to 1.66) in Canada and 1.57 (95% CI 1.56 to 1.58) in the US (p value for heterogeneity [p_H] = 0.3). The crude risk differences for preterm birth were 2.94 (95% CI 1.91 to 3.96) in Canada and 4.63 (95% CI 4.56 to 4.70) in the US (p_H = 0.003). Adjusted risk ratios for preterm birth (p_H = 0.1) were slightly higher in Canada than in the US, whereas adjusted risk differences were similar in both countries. Similar patterns were observed for racial disparities in very preterm birth.

Interpretation:

Relative disparities in preterm birth and very preterm birth between non-Hispanic black and white women were similar in magnitude in Canada and the US. Absolute disparities were smaller in Canada, which reflects a lower overall risk of preterm birth in Canada than in the US in both black and white populations.In the United States, a higher risk of preterm birth among black women than among white women is well established.^1–3 This racial disparity is of great concern because preterm birth is a leading cause of perinatal mortality and is predictive of developmental problems and adverse health outcomes later in life.⁴ The underlying causes of the racial disparity in preterm birth in the US are not well understood, although research has suggested contributing roles for a wide range of factors, including socioeconomic disadvantage,⁵ poor neighbourhood conditions (e.g., poverty, crime),^5,6 lack of access to health care,⁷ psychosocial stress,⁸ racial discrimination⁹ and adverse health behaviours.¹⁰Rates of preterm birth have consistently been lower in Canada than in the US.^11,12 However, in contrast to the US, little is known about differences in rates by race or ethnicity in Canada. There is evidence that African-born and Caribbean-born women in the provinces of Quebec and Ontario have higher rates of preterm birth than Canadian-born women.^13–15 Although the magnitude of these differences is smaller than the disparity in preterm births between black and white women in the US,¹⁶ foreign-born black women in the US have been found to be at lower risk of preterm birth than US-born black women.^17,18In both Canada and the US, socioeconomic conditions at both individual and neighbourhood levels are important predictors of preterm birth.^19–21 Although the income gap between black and white people is markedly smaller in Canada than in the US,²² black populations in both countries have lower education levels, higher unemployment rates and a greater likelihood of living in low-quality neighbourhoods compared with white populations.²³ Canada and the US share similar social and economic influences, yet the historical experiences of black populations and the social welfare systems (e.g., universal health care) are quite different in the 2 countries. Black people constitute about 13% of the total US population, but only about 3% of the Canadian population.^24,25 The overwhelming majority of Canada’s black population are immigrants who entered the country after 1960 and their descendants, whereas more than 85% of black Americans can trace their ancestry 3 or more generations in the US, with most being descendants of slaves.²²The objectives of our study are twofold. First, using data from a new cohort linking birth registrations with information from the 2006 Canadian long-form census, we present Canada-wide estimates of differences in preterm birth rates between black and white populations. Second, we use comparable methodology to compare racial differences in preterm birth rates between Canada and the US. Given different historical experiences of black populations in the 2 countries, as well as Canada’s commitment to universal health care and its general perception as a more egalitarian society than the US,²² we hypothesized that we would observe smaller racial disparities in the rates in Canada than in the US.     

Poverty in the United States as Defined by Federal Standards—Report of the Bureau of Research and Planning

The subject of this Socio-Economic Report is of tremendous importance to the medical profession because physicians should be aware that future programs for the expansion of health care services will be based and, in fact, are being based upon information which this Report contains. The relationship between poverty and accessibility of health care services is therefore quite direct. So, too, will be the impact upon the profession and the organization of medical practice.The 1966 amendments to the Poverty Act are concerned with neighborhood health centers and a vast array of other programs which will touch every physician and every community which can be identified by the standards indicated in this Report as low income, poor, or near poor. For this reason the California Medical Association Committee on Welfare Medical Programs, among several others concerned with aspects of this problem, is trying to alert every county medical society of developments as well as of the responsibilities they should assume in working with the Office of Economic Opportunity and other community organizations in providing guidance and leadership in structuring programs compatible with the interests of the public and the health care professions.This Report on poverty presents a current and prospective view of the problems and issues to be faced. Unless physicians see the relationship and join in a community effort to aid in resolving an issue which underlies public policy, we shall be looking back five or ten years from now to point out that we failed to take advantage of opportunities to assist in the development of a rational system of medical care for low-income groups.Individual physicians, component medical societies on a grass-roots level and CMA as a state organization should all be concerned with and aware of the facts.     

A period analysis of parity distribution among white and nonwhite women in the United States, 1940–1974

Abstract

The historical trends of childlessness and of one‐child, two‐child, and three‐or‐more‐child families among white and nonwhite women in the United States are studied in terms of period fertility tables. Given the age and parity of a woman, we can read from the fertility tables how her parity is expected to change at successive ages during the rest of her childbearing period, if she is subjected to the age‐parity‐specific fertility rates for a particular year. The fertility tables for white and nonwhite women are constructed for the years 1940, 19S0, 1960, 1970, and 1974. These tables show that among white women who have completed their childbearing (with period rates), the percentage with more than two children has decreased from 66 in 1960 to 27 in 1974, whereas the corresponding reduction among nonwhite women is from 67 to 48 per cent (Table 1, Case 1).     

Effects of Forest Regrowth and Urbanization on Ecosystem Carbon Storage in a Rural–Urban Gradient in the Southeastern United States

Forest regrowth after cropland abandonment and urban sprawl are two counteracting processes that have influenced carbon (C) sequestration in the southeastern United States in recent decades. In this study, we examined patterns of land-use/land-cover change and their effect on ecosystem C storage in three west Georgia counties (Muscogee, Harris, and Meriwether) that form a rural–urban gradient. Using time series Landsat imagery data including MSS for 1974, TM for 1983 and 1991, and ETM for 2002, we estimate that from 1974 to 2002, urban land use in the area has increased more than 380% (that is, 184 km²). Most newly urbanized land (63%) has been converted from forestland. Conversely, cropland and pasture area has decreased by over 59% (that is, 380 km²). Most of the cropland area was converted to forest. As a result, the net change in forest area was small over the past 29 years. Based on Landsat imagery and agricultural census records, we reconstructed an annual gridded data set of land-cover change for the three counties for the period 1850 to 2002. These data sets were then used as input to the Terrestrial Ecosystem Model (TEM) to simulate land-use effects on C fluxes and storage for the study area. Simulated results suggest that C uptake by forest regrowth (approximately 23.0 g C m⁻² y⁻¹) was slightly greater than the amount of C released due to deforestation (approximately 18.4 g C m⁻² y⁻¹), thus making the three counties a weak C sink. However, the relative importance of different deforestation processes in this area changed significantly through time. Although agricultural deforestation was generally the most important C-release process, the amount of C release attributable to urbanization has increased over time. Since 1990, urbanization has accounted for 29% of total C loss from the study area. We conclude that balancing urban development and forest protection is critically important for C management and policy making in the southeastern United States.     

Height and standard of living in Puerto Rico from the Spanish enlightenment to annexation by the United States, 1770–1924

This preliminary work presents a first series of heights of male adults in Puerto Rico. The sample, made up of 6000 prisoner records. the estimates were systematically assessed for selectivity, and we find that selectivity is quite negligible for the main results. The text studies the extreme dependence of the standard of living on the evolution of the price of sugar, a dependence which caused the progressive deterioration of material well-being in the country. Only between 1860 and 1880 did Puerto Ricans enjoy some improvement and a higher level of height. We measures the negative short-term effects of the 1898 annexation Puerto Rico by the United States.     

For what purpose the arts? An analysis of the mission statements of urban arts high schools in Canada and the United States

While general arts programs have declined in many schools across the United States and Canada, the number of specialized art programs in public secondary schools has swelled since the 1980s. While this increase is often celebrated by arts educators, questions about the justification of specialized arts programs are rarely raised, and their value is often taken for granted. In this article, we examine the mission statements of eighty-four specialized arts programs across two countries to examine the ideas, values, and commitments that are expressed in these public statements. In addition to a close thematic analysis, we describe how these mission statements reflect different conceptions of the role of the arts in education and consider the ways in which arguments that seek to broaden access to the arts are combined with the goal of serving a narrow subset of the student population. We argue that analyzing mission statements provides a clearer picture of the ideas that shape these programs, and that in order to foster an informed public conversation about the purpose and value of an education in the arts, educators committed to the arts must engage in this serious discussion.     

Regulation of biotechnology in the United States: One and a half years of using the ‘coordinated framework’

There are several organizations in the US with responsibilities for regulatory oversight of the planned introduction of recombinant DNA organisms into the environment. Equally, there are many kinds of projects which require assessment. The policies, recommendations and rulings of the various authorities have been integrated into a ‘Coordinated Framework’ which defines the operation of flexible case-by-case risk assessment. Additions to and revision of the guidelines are being made, a process which will continue in the light of new experience.     

Lung Cancer Incidence Trends by Gender,Race and Histology in the United States, 1973–2010

Background

Lung cancer (LC) incidence in the United States (US) continues to decrease but with significant differences by histology, gender and race. Whereas squamous, large and small cell carcinoma rates have been decreasing since the mid-80s, adenocarcinoma rates remain stable in males and continue to increase in females, with large racial disparities. We analyzed LC incidence trends by histology in the US with an emphasis on gender and racial differences.

Methods

LC incidence rates from 1973–2010 were obtained from the SEER cancer registry. Age-adjusted incidence trends of five major histological types by gender and race were evaluated using joinpoint regression. Trends of LC histology and stage distributions from 2005–2010 were analyzed.

Results

US LC incidence varies by histology. Squamous, large and small cell carcinoma rates continue to decrease for all gender/race combinations, whereas adenocarcinoma rates remain relatively constant in males and increasing in females. An apparent recent increase in the incidence of squamous cell carcinoma and adenocarcinoma since 2005 can be explained by a concomitant decrease in the number of cases classified as other non-small cell carcinoma. Black males continue to be disproportionally affected by squamous LCs, and blacks continue to be diagnosed with more advanced cancers than whites.

Conclusions

LC incidence by histology continues to change over time. Additional variations are expected as screening becomes disseminated. It is important to continue to monitor LC rates to evaluate the impact of screening on current trends, assess the continuing benefits of tobacco control, and focus efforts on reducing racial disparities.     

Cure by age and stage at diagnosis for colorectal cancer patients in North West England, 1997–2004: A population-based study

Background: Stage and age at diagnosis are important prognostic factors for patients with colorectal cancer. However, the proportion cured by stage and age is unknown in England. Materials and methods: This population-based study includes 29,563 adult patients who were diagnosed and registered with colorectal cancer during 1997–2004 and followed till 2007 in North West England. Multiple imputation was used to provide more reliable estimates of stage at diagnosis, when these data were missing. Cure mixture models were used to estimate the proportion ‘cured’ and the median survival of the uncured by age and stage. Results: For both colon and rectal cancer the proportion of patients cured and median survival time of the uncured decreased with advancing stage and increasing age. Patients aged under 65 years had the highest proportion cured and longest median survival of the uncured. Conclusion: Cure of colorectal cancer patients is dependent on stage and age at diagnosis with younger patients or those with less advanced disease having a better prognosis. Further efforts are required, in order to reduce the proportion of patients presenting with stage III and IV disease and ultimately increase the chance of cure.     

Assessing Double Counting of Carbon Emissions Between Forest Land-Cover Change and Forest Wildfires: A Case Study in the United States, 1992–2006

The relative contributions of double counting of carbon emissions between forest-to-nonforest cover change (FNCC) and forest wildfires are an unknown in estimating net forest carbon exchanges at large scales. This study employed land-cover change maps and forest fire data in the four representative states (Arkansas, California, Minnesota, and Washington) of the US for the period from 1992 to 2006 to evaluate forest carbon double counting effects based on land-cover change map, forest fire data, and USDA Forest Service Forest Inventory and Analysis data. The analyses were conducted at the county level and tallied to state level. Although the effects were small in the two eastern states because of small burned areas and low burn severity, substantial effects were found in the two western states. Carbon double counting was about 10 TgC (teragram 10¹²) in California and 6 TgC in Washington for the period 1992–2006 (at rates of 0.7 and 0.4 TgC per year), or 21.9 and 7.6% relative to total forest carbon emissions through FNCC in the two states, respectively. The effects were 0.2 and 0.1% in Arkansas and Minnesota, respectively. Variation in double counting effects within the states was also much higher in the western states compared with the eastern states. Our results suggested a general pattern that rates and amounts of double counting in forest carbon emissions between FNCC and fires were more evident and substantially different on a west–east dimension than that on a north–south dimension across the conterminous US during the study period.     

A Multi-Level Bayesian Analysis of Racial Bias in Police Shootings at the County-Level in the United States, 2011–2014

A geographically-resolved, multi-level Bayesian model is used to analyze the data presented in the U.S. Police-Shooting Database (USPSD) in order to investigate the extent of racial bias in the shooting of American civilians by police officers in recent years. In contrast to previous work that relied on the FBI’s Supplemental Homicide Reports that were constructed from self-reported cases of police-involved homicide, this data set is less likely to be biased by police reporting practices. County-specific relative risk outcomes of being shot by police are estimated as a function of the interaction of: 1) whether suspects/civilians were armed or unarmed, and 2) the race/ethnicity of the suspects/civilians. The results provide evidence of a significant bias in the killing of unarmed black Americans relative to unarmed white Americans, in that the probability of being {black, unarmed, and shot by police} is about 3.49 times the probability of being {white, unarmed, and shot by police} on average. Furthermore, the results of multi-level modeling show that there exists significant heterogeneity across counties in the extent of racial bias in police shootings, with some counties showing relative risk ratios of 20 to 1 or more. Finally, analysis of police shooting data as a function of county-level predictors suggests that racial bias in police shootings is most likely to emerge in police departments in larger metropolitan counties with low median incomes and a sizable portion of black residents, especially when there is high financial inequality in that county. There is no relationship between county-level racial bias in police shootings and crime rates (even race-specific crime rates), meaning that the racial bias observed in police shootings in this data set is not explainable as a response to local-level crime rates.     

Transcultural Diabetes Care in The United States – A Position Statement by the American Association of Clinical Endocrinologists

The American Association of Clinical Endocrinologists (AACE) has created a transculturalized diabetes chronic disease care model that is adapted for patients across a spectrum of ethnicities and cultures. AACE has conducted several transcultural activities on global issues in clinical endocrinology and completed a 3-city series of conferences in December 2017 that focused on diabetes care for ethnic minorities in the U.S. Proceedings from the “Diabetes Care Across America” series of transcultural summits are presented here. Information from community leaders, practicing health care professionals, and other stakeholders in diabetes care is analyzed according to biological and environmental factors. Four specific U.S. ethnicities are detailed: African Americans, Latino/Hispanics, Asian Americans, and Native Americans. A core set of recommendations to culturally adapt diabetes care is presented that emphasizes culturally appropriate terminology, transculturalization of white papers, culturally adapting clinic infrastructure, flexible office hours, behavioral medicine—especially motivational interviewing and building trust—culturally competent nutritional messaging and health literacy, community partnerships for care delivery, technology innovation, clinical trial recruitment and retention of ethnic minorities, and more funding for scientific studies on epigenetic mechanisms of cultural impact on disease expression. It is hoped that through education, research, and clinical practice enhancements, diabetes care can be optimized in terms of precision and clinical outcomes for the individual and U.S. population as a whole.Lay AbstractThe American Association of Clinical Endocrinologists (AACE) has created a diabetes care model for patients of different backgrounds. AACE led meetings in New York, Houston, and Miami with health care professionals and community leaders to improve diabetes care. Information from these meetings looked at biological and environmental diabetes risks. Four American patient groups were studied: African Americans, Latinos, Asian Americans, and Native Americans. Diabetes care should use culturally appropriate language and search for better ways to apply science and clinic design. Talking to patients more clearly can improve their diabetes control. There are many other needed changes in the American health care system discussed in this paper. It is hoped that through better education, research, and practice, diabetes care can be improved for the entire U.S. population. This means that important differences among patients' ethnic and cultural backgrounds are addressed.Executive Summary

• Cultural adaptation of evidence-based recommendations is a necessary component of optimal diabetes care.
• Biological factors that contribute to the pathophysiology of diabetes vary according to race and ethnicity and can be affected by social determinants that vary with culture.
• The “Transcultural Diabetes Nutrition Algorithm” was developed in 2010 to optimize diabetes nutrition care globally and represents a validated methodology where evidence-based recommendations from a source culture can be adapted and implemented in a different culture using a toolkit.
• The 2015 AACE Pan-American Workshop examined diabetes care in 9 Latin American nations and concluded that there should only be one level of diabetes care for a population and that level should be “excellent;” also, that A1C measurements should be utilized and that more educational and nutritional options are needed to optimize diabetes care.
• The “Diabetes Care Across America – A Series of Transcultural Summits” was an AACE program conducted in 2017 in New York, Houston, and Miami to examine cultural factors that influence diabetes care domestically; the findings of this program are presented here.
• The African American, Hispanic/Latino, Asian American, and Native American populations are each comprised of different ancestries, anthropometrics/body compositions and physical appearances, and cultures and degrees of acculturation, with a significant evidence base that associates specific gene variants with specific phenotypic traits affecting diabetes care.
• For each ethno-cultural population, health messaging and diabetes care will need to consider issues of potential distrust of health care professionals, history of discrimination, religious practices, food preferences, attitudes toward physical activity, and despite the full range of socio-economics, the impact of poverty on engagement, self-monitoring, adherence with lifestyle and medical recommendations, and recruitment for clinical trials.
• Diabetes care should be as precise as possible, incorporating clinical trial evidence that best reflects the ethno-cultural attributes of a specific patient, with particular emphasis on cardiovascular disease risk mitigation, technology to assess the effects of eating patterns on glycemic status, adjusting traditional eating patterns to more healthy options that are still acceptable to the patient, flexibility in lifestyle and medication recommendations that take into account cultural factors, and the utilization of community-based resources to improve implementation.
• Pragmatic first steps to prepare a diabetes practice for an ethno-culturally diverse patient population include: learning more about biological-cultural interactions; gaining experience with lifestyle and behavioral medicine, especially motivational interviewing; creating a safe and immersive clinical environment; incorporating translation services, social prescribing, wearable technologies, web-based resources, and community engagement; and establishing referral networks with clinical trialists in diabetes research to improve recruitment of different populations.

ABSTRACTAbbreviations: A1C = hemoglobin A1c; AACE = American Association of Clinical Endocrinologists; ABCD = adiposity-based chronic disease; BMI = body mass index; CPA = clinical practice algorithm; CPG = clinical practice guideline; DBCD = dysglycemia-based chronic disease; DPP = Diabetes Prevention Program; GWAS = genome-wide association study; HCP = health care professional(s); IHS = Indian Health Service; LDL = low-density lipoprotein; MetS = metabolic syndrome; T2D = type 2 diabetes mellitus; tDNA = transcultural Diabetes Nutrition Algorithm; TG = triglyceride; WC = waist circumference     

Milkweed—A war strategic material and a potential industrial crop for sub-marginal lands in the United States

In 1943 the U. S. Federal Government erected a milk weed floss- and seed-extracting plant at Petoskey, Michigan, the only one of its kind in the world, and in one year this plant furnished to the armed forces two million pounds of milkweed floss that was used in lieu of kapok from Java in the manufacture of life saving equipment. Two million pounds of seed and tons of fibers were by-products as potential commercial sources of oil and cellulose, respectively.