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Humans commit more violent crimes when temperature and air pollution is higher. Here, we investigate if also the day-to-day rates of dogs biting humans is influenced by environmental factors. 69,525 reports of dogs biting humans, sourced from public records on animal control requests and from ER records, were analyzed. The impact of temperature and air pollutants were evaluated with a zero-inflated Poisson generalized additive model, while controlling for regional and calendar effects. Exposure–response curves were used to assess the association between outcome and major exposure variables. We find that the rates of dogs biting humans increases with increasing temperature and ozone, but not PM 2.5 exposure. We also observed that higher UV irradiation levels were related to higher rats of dog bites. We conclude that dogs, or the interactions between humans and dogs, are more hostile on hot, sunny, and smoggy days, indicating that the societal burden of extreme heat and air pollution also includes the costs of animal aggression.

Background Bariatric surgery is the most effective treatment for obesity; however, some patients experience significant weight regain. Weight loss medications (WLM) are being increasingly used in surgery patients with limited evidence. We examine weight loss outcomes in patients using WLM after bariatric surgery. Methods In a retrospective study, 197 bariatric surgery patients who started WLM between 2016 and 2019 at a single center were analyzed. Patients were categorized into 3 groups based on outcomes of the initial surgery: (1) Weight regainers (WR) = achieved goal weight loss after surgery (15% total body weight loss (TBWL) for sleeve gastrectomy (SG) and 25% TBWL for Roux-en-Y gastric bypass (RYGB)) with subsequent regain of > 20% of weight lost; (2) Adequate weight loss (AWL) = achieved goal weight loss without > 20% weight regain; (3) Non-responders (NR) = never achieved goal weight loss. Weight loss and medication use patterns were analyzed. Results Among the three categories, there was no significant difference in duration of medical therapy or %TBWL with medications. RYGB patients lost more weight than SG patients using WLM ( p  = 0.03). Of the medications used, patients treated with phentermine + topiramate had the highest likelihood of achieving 5%, 10%, and 15% weight loss. Compared to other 2 groups, AWL group initiated WLM earlier and experienced more weight loss when compared to their pre-operative weight or post-operative nadir. Conclusions RYGB patients respond better to WLM than SG patients. Those who had started WLM before regaining weight (AWL) experienced greater overall weight loss, suggesting that proactive medical therapy at the time of weight plateau can help with greater total weight loss. Phentermine + topiramate is the most effective WLM in post-bariatric surgery patients.

Lockdown measures implemented in response to the COVID-19 pandemic produced sudden behavioral changes. We implement counterfactual time series analysis based on seasonal autoregressive integrated moving average models (SARIMA), to examine the extent of air pollution reduction attained following state-level emergency declarations. We also investigate whether these reductions occurred everywhere in the US, and the local factors (geography, population density, and sources of emission) that drove them. Following state-level emergency declarations, we found evidence of a statistically significant decrease in nitrogen dioxide (NO 2 ) levels in 34 of the 36 states and in fine particulate matter (PM 2.5 ) levels in 16 of the 48 states that were investigated. The lockdown produced a decrease of up to 3.4 µg/m 3 in PM 2.5 (observed in California) with range (− 2.3, 3.4) and up to 11.6 ppb in NO 2 (observed in Nevada) with range (− 0.6, 11.6). The state of emergency was declared at different dates for different states, therefore the period \"before\" the state of emergency in our analysis ranged from 8 to 10 weeks and the corresponding \"after\" period ranged from 8 to 6 weeks. These changes in PM 2.5 and NO 2 represent a substantial fraction of the annual mean National Ambient Air Quality Standards (NAAQS) of 12 µg/m 3 and 53 ppb, respectively. As expected, we also found evidence that states with a higher percentage of mobile source emissions (obtained from 2014) experienced a greater decline in NO 2 levels after the lockdown. Although the socioeconomic restrictions are not sustainable, our results provide a benchmark to estimate the extent of achievable air pollution reductions. Identification of factors contributing to pollutant reduction can help guide state-level policies to sustainably reduce air pollution.

BackgroundFollowing publication of the AMAROS trial, we sought to optimize axillary lymph node dissection (ALND) or postmastectomy radiation therapy (PMRT) + axillary radiation (AxRT) utilization in cT1-2N0 patients with 1–2 positive sentinel lymph nodes (SLNs) after mastectomy.MethodsIn November 2015, our multidisciplinary group implemented a protocol to omit intraoperative SLN evaluation for mastectomy patients with cT1-2N0 breast cancer likely to be recommended PMRT if found to have 1–2 positive SLNs (age ≤ 60 years and/or high-risk features defined as estrogen receptor-negative and/or positive for lymphovascular invasion). We prospectively evaluated axillary management, short-term complications, and oncologic outcomes in patients with 1–2 positive SLNs.ResultsFrom November 2015 to December 2018, 479 of 560 (85%) cT1-2N0 breast cancers treated with mastectomy were potential candidates for PMRT. Intraoperative SLN evaluation was omitted in 344 (72%), thus following the protocol. Overall, 121 cases had 1–2 positive SLNs: 17 (14%) were managed with observation, 5 (4%) PMRT alone, 59 (49%) PMRT + AxRT, 16 (13%) ALND alone, and 24 (20%) ALND + PMRT. Protocol compliance resulted in less ALND (8% vs. 24%) and less ALND + PMRT (9% vs. 41%, p < 0.01). At median follow-up of 24 months, there was one regional and four distant recurrences, with no regional recurrences or differences in disease-free survival in patients treated with ALND versus PMRT + AxRT (100% vs. 98%, p = 0.67). Similarly, there were no differences in complication rates (p = 0.18). ConclusionsOmitting intraoperative SLN evaluation in cT1-2N0 mastectomy patients who would be candidates for PMRT if found to have positive nodes decreased rates of ALND and minimized use of ALND + PMRT without compromising outcomes.

To investigate air pollution’s effect in the form of PM 2.5 (particulate matter measuring less than 2.5 microns) on head and neck aerodigestive cancer incidence, an epidemiological cohort analysis was performed using data from the Surveillance Epidemiology and End Results national cancer database from the years 2002–2012. The relationship between US county mean PM 2.5 levels and head and neck cancer (HNC) incidence rates were examined using a linear mixed model. Lagged effect of the pollutant’s effect on HNC incidence was analyzed. Our results showed a significant association between the incidence of HNC and certain subtypes with PM 2.5 exposure after controlling for demographic characteristics, smoking and alcohol use. We observed the highest association at a 5-year lag period (β = 0.24, p value < 0.001). We observed significant associations at no lag (β = 0.16, p value = 0.02) and up to a 20-year lag period (β = 0.15, p value < 0.001). PM 2.5 exposure is associated with an increased incidence of HNC, with the strongest association at a 5-year lag period. To better understand the relationships between exposure and cancer pathogenesis, further subgroup analysis is needed.

BackgroundNo consensus exists for optimal staging following neoadjuvant chemotherapy (NAC). We compared the performance of the American Joint Committee on Cancer (AJCC) pathologic prognostic staging system, Residual Cancer Burden (RCB) Index, and the Neo-Bioscore in breast cancer patients after NAC.MethodsPatients with stage I–III breast cancer who received NAC at Dana-Farber Cancer Institute from 2004 to 2014 were identified. Kaplan–Meier curves were used to estimate disease-free survival (DFS) and overall survival (OS), and model fits were compared by receiver operator characteristic (ROC) curve using the c-statistic and DeLong’s test.ResultsOverall, 802 patients with a median age of 48 years received NAC. Most patients presented with cT2 (n = 470, 58.6%) and cN1 (n = 422, 52.6%) disease. The subtype was estrogen receptor (ER)- and/or progesterone receptor (PR)-positive/human epidermal growth factor receptor 2 (HER2)-negative in 296 (36.9%) patients, HER2-positive in 261 (32.5%) patients, and triple-negative in 245 (30.5%) patients. Median follow-up was 79.5 months. There were 174 recurrences (30 local, 25 regional, 145 distant), with 676 (76.8%) patients alive at last follow-up. AJCC pathologic prognostic staging and RCB had better discrimination for estimated 7-year DFS and OS compared with the Neo-Bioscore. The ROC c-statistics for DFS model fit were similar for AJCC pathologic prognostic stage (0.72) and RCB (0.71, p = non-significant); both had improved model fit versus the Neo-Bioscore (0.65, p < 0.01). The c-statistics for OS were 0.74, 0.71, and 0.70 for AJCC pathologic prognostic stage, RCB, and Neo-Bioscore, respectively (p = non-significant).ConclusionsThese results validate the ability of these staging systems to stratify survival outcomes in NAC patients, with best discrimination achieved using AJCC pathologic prognostic stage or RCB.

The goal of this study was to expand our previously created prediction tool (PREDICT-AVF) and web app by estimating long-term primary and secondary patency of radiocephalic AVFs. The data source was 911 patients from PATENCY-1 and PATENCY-2 randomized controlled trials, which enrolled patients undergoing new radiocephalic AVF creation with prospective longitudinal follow up and ultrasound measurements. Models were built using a combination of baseline characteristics and post-operative ultrasound measurements to estimate patency up to 2.5 years. Discrimination performance was assessed, and an interactive web app was created using the most robust model. At 2.5 years, the unadjusted primary and secondary patency (95% CI) was 29% (26–33%) and 68% (65–72%). Models using baseline characteristics generally did not perform as well as those using post-operative ultrasound measurements. Overall, the Cox model (4–6 weeks ultrasound) had the best discrimination performance for primary and secondary patency, with an integrated Brier score of 0.183 (0.167, 0.199) and 0.106 (0.085, 0.126). Expansion of the PREDICT-AVF web app to include prediction of long-term patency can help guide clinicians in developing comprehensive end-stage kidney disease Life-Plans with hemodialysis access patients.

Introduction Interpersonal violence (IPV) among children and adolescents represents a significant global public health problem. While Mexico has recorded an increase in IPV, its distribution and management remain understudied. We aim to investigate the epidemiology of IPV cases among children and adolescents in Mexico. Methods This retrospective registry-based analysis used a nationwide injury dataset ( Lesiones) from the Mexican Ministry of Health. We included medical records of IPV victims aged 0 to 17 years who presented at public health facilities in Mexico from 2015 to 2022. We used stratified descriptive statistics to summarize the distribution, management, and outcomes of IPV. Categorical variables were compared between male and female victims, as well as across age categories, using chi-square tests. Additionally, we generated a heatmap to visually represent the average IPV cases per 100,000 children and adolescents across Mexican states. Results Among 116,287 IPV victims, 36,385 (31.3%) were male and 79,902 (68.7%) female. The majority were aged 15–17 years ( n  = 62,616; 53.8%), followed by those aged 10–14 years ( n  = 34,234; 29.4%), 5–9 years ( n  = 12,219; 10.5%), and under 5 years ( n  = 7,218; 6.2%). Most had a secondary education ( n  = 32,509; 28.0%), and literacy levels were high, with 86,858 (74.7%) reported as literate. Among female victims, 11,207 (14.0%) were pregnant at the time of the IPV incident. Among all victims, physical abuse ( n  = 39,155; 33.7%) was the most common form of violence, followed by mental abuse ( n  = 38,759; 33.3%) and sexual abuse ( n  = 38,373; 33.0%). Among males, 73.5% ( n  = 26,743) were affected by physical abuse, whereas among females, 44.4% ( n  = 38,373) experienced sexual abuse. Family violence accounted for 57.1% ( n  = 66,407) of all medical records. The states with the highest average IPV cases per 100,000 children and adolescents were Guanajuato (83.8) and Chihuahua (80.0). Most aggressors were male ( n  = 76,909; 66.1%). Conclusion This study analyzed IPV cases among children and adolescents in Mexico. Findings highlight the need for multi-faceted, age- and gender-specific interventions. Strengthening laws and policies, with a focus on reporting, enforcement, and mandatory training, is essential to protect children and adolescents from IPV.

BackgroundLaparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgical procedure. Little is known about how surgeon training background influences the learning curve of this procedure. We examined operating times (OT), weight loss outcomes, and 30-day complications between surgeons with and without fellowship training in LSG. We hypothesize that post-residency training specific to LSG influences learning curves. MethodsSurgeons from a single institution were split into two groups: those who had not completed fellowship training in LSG (NF, n = 3), and those who had completed LSG specific training in fellowship (SGF, n = 3). OTs, BMI changes at 1 year, and 30-day readmissions, reoperations, and complications were extracted for the first 100 LSG cases of each surgeon. Data were analyzed in bins of 20 cases. Comparisons were made between cohorts within a bin and between adjacent bins of the same surgeon cohort. Logistic regression analyses were performed of OT and weight loss outcomes.ResultsSGF surgeons showed no difference in OTs over their first 100 cases. NF surgeons had statistically significant increased OTs compared to SGF surgeons during their first 60 cases and progressively shortened OTs during that interval (109 min to 78 min, p < 0.001 for NF surgeons vs. 73 min to 69 min, SGF surgeons). NF surgeons had a significantly steeper slope for improvement in OT over case number. There was no correlation between case number and weight loss outcomes in either group, and no differences in 30-day outcomes between groups.ConclusionSurgeons who trained to perform LSG in fellowship demonstrate faster and consistent OR times on their initial independent LSG cases compared to surgeons who did not, with no correlation between case number and weight loss outcomes or safety profiles for either group. This suggests that learning curves for LSG are achieved during formal case-specific fellowship training.