Lakewood Regional Medical Center

Purpose: Kidney cancer mortality in the United States exhibits persistent racial, ethnic, and geographic disparities, yet regional patterning of these disparities over time remains incompletely characterized. We conducted a retrospective analysis using national mortality data to examine differences in kidney cancer mortality between U.S. Mexico border and non-border regions from 2000 through 2020.Materials and Methods: Death records were obtained from CDC WONDER, and kidney cancer deaths were identified using ICD 10 code C64 as the underlying cause of death. We evaluated C64 to C65 in sensitivity analyses, including C65 separately. We compared demographics, age adjusted mortality rates, and temporal trends by border residence. Multivariable logistic regression assessed demographic patterning of deaths across regions, and Joinpoint regression evaluated changes in age adjusted mortality trends over time.Results: A total of 279,117 kidney cancer related deaths were recorded nationally. Hispanic decedents were disproportionately represented among border state deaths (22.9% vs 2.8% in non-border states). Border states accounted for 67.4% of Hispanic C64 deaths. Age distribution and racial composition of decedents differed between border and non-border regions (all p<0.001). In multivariable analyses, Hispanic ethnicity was strongly associated with border state residence among decedents, independent of age and race. Joinpoint regression identified multiple periods of change in mortality trends, with statistically significant increases in non-border regions and less precise segment estimates in border regions.Conclusion: Kidney cancer deaths among Hispanic decedents show substantial geographic concentration in U.S. Mexico border states. These findings support surveillance strategies and interventions that incorporate geographic context in efforts to reduce kidney cancer mortality disparities.

Black women in the United States face maternal mortality rates three to four times higher than their White counterparts despite advancements in obstetric care. Structural racism, gendered stereotypes, psychosocial stressors, and intersecting oppressions amplify the risk of adverse maternal health outcomes. This is part of a broader " dual burden" or stigma of being both Black and a woman. To further explain this dual burden, this study introduces the concept of "Black Tears" as an analytical framework that synthesizes the intersecting crises shaping Black maternal health. This qualitative study examines how psychosocial stressors, and institutional inequities intersect to shape Black maternal experiences. This study employed an interpretive (hermeneutic) phenomenological approach to explore the lived experiences of Black mothers. Five Black and one Black Hispanic woman (aged 18-32) who had given birth in Kansas or Missouri participated in in-depth semi-structured interviews. Guided by an integrated framework of Critical Race Theory (CRT), the SBW schema, and interpretive phenomenology, transcripts were analyzed to uncover the essential themes of their maternal healthcare encounters. Three interrelated themes emerged: [1] the invalidation of embodied knowledge: dismissal of pain and concerns [2], the performance of strength: suppressing vulnerability to be heard, and [3] the weight of systemic bias: navigating a hostile environment. These findings reveal the persistent "tears" of Black women's maternal health concerns and the normalization of their suffering within medical contexts. Black women's maternal experiences are shaped by historical inequities, racialized stereotypes, and institutional neglect. The endorsement of the SBW stereotype has been shown to lead to coping strategies like "identity shifting," where Black women alter their behaviors to mitigate discrimination. Culturally responsive care models, provider training, and policy reforms centered on Black maternal voices are urgently needed to disrupt systemic harms.

The Lakewood Interceptor Tunnel in Lakewood, Ohio (pop. >50,000), was originally constructed from 1918 to 1945 by tunnelling methods largely through rock strata at depths varying from 20 ft to 94 ft. It carries over 77% of the wastewater flow for the city of Lakewood (city) and is over 20,000 ft long. The egg-shaped pipe is 56.5-in. high by 42.5-in. wide and was predominately constructed with clay tile segmental block pipe with localized areas constructed with conventional brick. It is being rehabilitated using segmental Glass Reinforced Plastic (GRP) composite pipe sliplined with a fully grouted annulus. The structural design of the liner utilized the ASCE MOP 145 (2021)—Design of Close-Fit Liners for The Rehabilitation of Gravity Pipe. In 2021, the city noticed an increase in the frequency of localized collapses of the tunnel roof. This initiated a condition assessment (CA) program of the entire interceptor to evaluate options to rehabilitate the tunnel to eliminate further collapses and provide the entire interceptor with a new design life. The CA program utilized a multi-sensor platform equipped with high-definition CCTV, time-of-flight LIDAR profiling above the flowline, and SONAR profiling below the flowline to quantify condition both visually and dimensionally. The inspections revealed severe mortar loss in brick sections, movement and instability of the sewer walls, and localized loss of the crown of the tunnel in many areas. The rock strata prevented migration of the collapse to the surface, but overall, the assessment indicated that large sections of the tunnel were in a state of incipient failure that warranted widespread structural rehabilitation. The depth of the tunnel, its proximity to residences and apartment complexes, and the large flow volume created many challenges for rehabilitation. Based on a review of a wide array of rehabilitation techniques, the use of segmental GRP composites was selected due to its ability to be matched to a wide array of subtle cross section changes, overall constructability given the unique site conditions, ability to be installed without bypassing sewer flows, and life cycle cost considerations. Type testing criteria were developed to facilitate design of the lining based on 100-year life objectives and the construction phase includes a verification process to confirm that all core design objectives can be confirmed as being met in the construction phase. The project was bid in January 2023 and awarded for $25.4 million. This paper provides a detailed overview of the assessment and design process and an update on construction progress and challenges.

BackgroundIs there a statistically significant association between preoperative epidural steroid injections (ESI) and postoperative cervical and lumbar spinal surgery infections (SSI)? MethodsA systematic review and meta-analysis was completed of patients 18 years or older who underwent elective cervical or lumbar spinal surgery. Those who underwent surgery with preoperative ESI were compared to those without. We assessed for differences in postoperative SSI incidence. Electronic literature databases were searched through October 2022. Peer-reviewed publications that included raw data regarding epidural exposure and non-exposure were included. Case reports, case series, abstracts, editorials, or publications that did not include raw data were excluded. Odd's ratios (OR) were calculated from the raw data collected. Meta-analysis was done using RevMan v5 with a fixed effects model. ResultsWe identified 16 articles for inclusion. When not controlling for the type of surgery and time from ESI to surgery, there was a statistically significant OR between preoperative ESI and postoperative SSI. The association persisted when the ESI was performed within 30 days or 31-90 days of the surgery. No association was discovered when evaluating only cervical spine surgeries. The evidence is assigned a “moderate” GRADE rating. ConclusionOur analysis shows a small, time-dependent, statistically significant association between preoperative ESI and postoperative lumbar SSI may exist. However, the OR produced, while statistically significant, are close enough to 1.0 that clinically, the effect size is “small.” The number needed to treat for an ESI in the appropriate clinical setting is, at worst, 3. The number needed to harm, meaning the number of patients who undergo an ESI at any time before their spine surgery and then develop a SSI, is 111 patients. Ultimately, the surgical sparing potential from an ESI outweighs the SSI risk based on our findings.

Polypharmacy, or the use of 5 or more daily medications, is common in adults with multiple sclerosis (MS), and is often due to various physical, cognitive, and emotional symptoms. However, research regarding the association between polypharmacy and cognitive outcomes in MS is sparse. Furthermore, individuals with MS often use medications with anticholinergic properties, which are commonly associated with cognitive impairment and other central nervous system adverse effects. Currently, the utility of scales measuring anticholinergic burden in MS is unknown. This study aims to investigate the relationship between polypharmacy, anticholinergic burden, and objective cognitive performance in MS. We recruited 90 individuals with MS during routine visits at an MS specialty clinic in Kansas City. Participants completed a brief, virtual cognitive assessment and answered questions about their health. Participants provided their medication lists from which we determined polypharmacy and scores on several anticholinergic burden scales. Statistical analyses included Spearman correlations and linear regression models. Approximately 44% of the individuals surveyed met the criteria for polypharmacy. The number of daily medications was negatively correlated with cognitive performance (rs = -0.45, P < .001). Further, the Drug Burden Index accounted for additional variance in cognitive performance beyond that explained by age, education, MS disease duration, and comorbidities [ΔR2 = .12, F(5, 84) = 7.84, P < .001.]. Clinicians should consider the possible negative consequences of polypharmacy when addressing cognitive concerns in MS. Anticholinergic burden scales may be valuable in this regard. Future investigations could explore behavioral and pharmacological interventions aimed at reducing polypharmacy in MS.

Forum papers are thought-provoking opinion pieces or essays founded in fact, sometimes containing speculation, on a civil engineering topic of general interest and relevance to the readership of the journal. The views expressed in this Forum article do not necessarily reflect the views of ASCE or the Editorial Board of the journal.

Introduction: Elderly patients (age &gt; 75) sustain larger infarcts with greater mortality from STEMI despite successful TIMI III reperfusion. Elderly age is an independent risk despite correction for clinical and angiographic variables. Mitochondria (MITO) are key mediators of injury during ischemia (ISC) and reperfusion (R) in lab studies. The acute, transient blockade of the MITO electron transport chain (ETC) at complex I during R decreases infarct size in adult heart models. Metformin (MET) inhibits ETC complex I. Hypothesis: Acute, high dose MET given at R in high-risk aged STEMI model hearts will reduce infarct size. Methods: Young (3-6 mo) and aged (22-24 mo) C57BL/6J mice, male and female (NIA), underwent in vivo ISC-R surgery via 45 min LAD ligation. At 5 min pre-R, 2 mM MET (or vehicle) was injected via jugular vein. At 24-hr R infarction size and area at risk (AAR) were measured. Echo was performed pre-ISC and end-R. Results: MET treatment at R improved contractile function [ejection fraction (EF) and fractional shortening (FS)] following 24 hr R in both male and female aged groups as well as in the young heart (Figure A)(mean ± SD). MET at R substantially decreased infarct size in both sexes in the aged heart (Figure B) to a similar extent as in the young hearts. AAR was similar in all groups. Conclusions: Acute, high dose MET treatment directly before R decreased infarction and improved contractile function at 24 hr R in aged murine hearts. This is the initial step to move acute MET toward consideration as a cath lab treatment via intracoronary infusion immediately following R via PCI for elders suffering STEMI to reduce injury and preserve function.