Urban tree canopy is known to mitigate ambient heat and improve physical and mental health but the longitudinal interactions and impacts of tree canopy, temperature, and mortality are not well understood. Using high resolution tree canopy estimates, temperature, mortality, and demographic data from 2011 to 2021, we implemented negative binomial generalized estimating equations to model all-cause and disease-specific mortality based on tree canopy cover, year-to-year changes in tree canopy cover, and maximum temperature, adjusting for area-level demographics in Chicago, IL. We used K-means clustering to identify patterns of canopy, temperature, and mortality disparities across Chicago community areas. There were 220,711 decedents during the study period (115,974 male, 104,734 female; mean age at death: 69.4 ± 19.9 years). Existing canopy coverage was not statistically significantly associated with mortality (incidence rate ratio [IRR] = 0.995, 95% confidence interval [CI] = 0.984-1.007). However, each year-to-year percent increase in canopy was associated with around a 10% reduction in mortality (IRR = 0.902, [0.871-0.935]) with significant associations for cause-specific cardiovascular (IRR = 0.908, [0.869-0.948]), mental health (IRR = 0.836, [0.784-0.892]), musculoskeletal (IRR = 0.907, [0.832-0.989]), and respiratory (IRR = 0.887, [0.833-0.945]) diseases. Cluster analysis identified that neighborhoods on Chicago's South and West sides were characterized by high temperatures, greater absolute canopy loss despite elevated baseline canopy levels, and increased mortality. Among the hottest neighborhoods, canopy-temperature interaction models demonstrated that areas experiencing larger year-to-year canopy losses had higher yearly mortality. Protecting tree canopy cover from losses over time, particularly in vulnerable areas with higher temperatures, may present a key opportunity to reduce mortality and mitigate impacts of climate change.

Electric vehicle adoption strategies have the potential to reduce greenhouse gas and air pollutant emissions. However, the effectiveness of this transition may depend on which vehicles are electrified, and where. To assess the efficacy of different modes of transportation electrification, we apply a watts-to-wheel analysis framework that accounts for upstream emission increases from battery charging and downstream reductions in tailpipe emissions. Using the WRF-CMAQ chemical transport model at ∼1 km ^2 resolution, we compare the greenhouse gas, air quality, and public health impacts of electrifying 30% of light-duty vehicles (eLDVs) versus 30% of heavy-duty vehicles (eHDVs) across a U.S. Midwestern domain. Both electrification scenarios achieve net reductions in CO _2 emissions despite increased emissions from electricity generation units, with greater total reductions from eLDVs (∼7 Mt CO _2 /year, −4.5%) than eHDVs (∼1.6 Mt CO _2 /year, −1.1%). However, air quality benefits are greater in the eHDV scenario, where cumulative reductions in health-harming air pollutants such as nitrogen dioxide (NO _2 ) and elemental carbon (EC) exceed those in the eLDV scenario. Both scenarios show modest increases in daily 8 h average ozone (MDA8 O _3 ), with disbenefits largest in the eHDV scenario. Estimated health benefits of the eHDV scenario exceed those of the eLDV scenario, with 70 (50) more avoided premature deaths annually from reduced NO _2 (EC), offset by 50 additional deaths from MDA8 O _3 increases. In both scenarios, the largest health benefits occur in communities with higher proportions of Black and Hispanic residents. However, long-standing relative exposure disparities persist. On a per-vehicle basis, we find that electrifying one HDV yields nearly 5× more CO _2 reduction-based economic benefits and 23× more NO _2 reduction-based economic health benefits than a single eLDV. Our results demonstrate that multi-modal and multi-pollutant assessments are critical for informing more effective and equitable decarbonization and air pollutant remediation strategies.

Chronic traffic related air pollution (TRAP) exposure is linked to various adverse health outcomes including pediatric and adult asthma incidence, but more importantly can also lead to premature mortality. In the U.S., the majority of people living close to high volume and density roadways are people of color who are exposed to disproportionate levels of associated health harming primary and secondary air pollutants such as NOx (NO + NO2; key precursors for O3 formation) and PM2.5 as well as greenhouse gases (e.g. CO2). Both heavy- and light-duty vehicles (HDVs/LDVs) contribute to on-road TRAP but on a per vehicle basis, the associated air quality and public health impacts are larger for HDVs. One potential climate mitigation strategy is the shift of the transportation sector to battery powered alternatives (EVs). However, the associated air quality, health and equity implications of such a transition are not well understood and lack characterization at fine intra-urban spatial scales.Given non-linear atmospheric chemistry associated with the formation of secondary pollutants (e.g O3), and the steep spatial gradients exhibited by short lived TRAP (e.g. NO2), here we use the two-way coupled Weather Research Forecast and Community Multiscale Air Quality (WRF-CMAQ) chemical transport model at 1.3 km to determine changes in simulated NO2, O3 and PM2.5 concentrations from the electrification of 30% of HDVs and LDVs over a central U.S. Midwestern domain. We represent changes in on-road, refueling and idling emissions as well as power plant emissions from the increased electricity demand needed for charging. Altered emissions are then used as inputs to run a month-long simulation for each season. Incorporating high resolution concentration changes with census tract level health data, we estimate changes in health impacts at the census tract level and across different population subgroups.We find that electrifying 30% of primarily diesel-fueled HDVs reduces NOx emissions by a factor of 10 for each vehicle mile compared to the NOx reductions associated with electrifying 30% of LDVs. We simulate domain-wide annual mean NO2 (~-10%) and PM2.5 (~-2%) reductions that peak along major roadways, however MDA8O3 concentrations increase in urban cores. If 30% HDVs and LDVs are electrified, we estimate that 1,120 and 170 annual premature deaths linked to NO2 and PM2.5 would be avoided, respectively while 80 annual premature deaths associated with MDA8O3 would be added. Additionally, we find that the largest simulated air quality and health benefits are within communities of color. Notably, we find that while the domain as a whole is only 12% Black, communities with the largest NO2-related health benefits are 45% Black. Our results demonstrate that incentives aimed at reducing transportation related emissions, especially from HDVs, are beneficial from a climate perspective but also from an air quality, health and economic perspective with the potential to reduce long standing environmental injustices.

Affecting over 230 million people worldwide, peripheral artery disease (PAD) is a chronic disease that can lead to significant functional deficits, amputation, and death. Early detection of PAD is critical as risk factor modification and medical management can slow disease progression. It was not until the mid-twentieth century that arterial reconstruction surgery was developed for PAD but even then there was no tool to objectively and reliably assess postoperative success. At the beginning of his career, James S.T. Yao, M.D., Ph.D., published groundbreaking work on the ankle-brachial index (ABI) as a reliable diagnostic tool that would change the field of vascular surgery forever. In 1969, Yao pioneered the ABI, which objectively assessed the presence and severity of PAD by comparing a patient’s ankle and brachial systolic blood pressures. His landmark paper revealed that the ABIs of patients with PAD correlated with clinical severity, and patients with successful revascularization experienced an increase in ABI. These measurements were effective and accessible, requiring minimal equipment and training to perform. Over 50 years later, the ABI is still recognized as the leading diagnostic tool for PAD by current American Heart Association, American College of Cardiology, and Center for Disease Control guidelines.

BACKGROUND:The American College of Surgeons Commission on Cancer (ACS CoC) has recommended lymph node sampling from 3 mediastinal stations and 1 hilar station, while the European Society of Thoracic Surgeons (ESTS) has recommended a lobe-specific lymph node station sampling strategy for lung cancer resection. Comparative postoperative complications associated with these strategies are unknown. The objective of this study is to evaluate the association of lymph node sampling strategy on postoperative outcomes for lung cancer patients. METHODS:We conducted a retrospective cohort analysis of elective lung cancer resections from 2018-2023 in a single health system. We performed multivariable Poisson regression with robust variance to evaluate the association of any 30-day postoperative complications and major 30-day postoperative complications across lymph node sampling criteria. RESULTS:Of 964 total patients, 524 (54.4%) met ACS CoC, 121 (12.6%) met ESTS, and 428 (44.4%) met neither criteria. Risk-adjusted rates of 30-day postoperative complications were not significantly different between ACS CoC (29.8%), ESTS (27.8%), and neither criteria (34.4%). Risk-adjusted rates of major 30-day postoperative complications were similar between ACS CoC (17.7%) and neither criteria (13.6%) but lower for those meeting ESTS criteria (13.6%, aRR 0.76 95% CI 0.68-0.86). CONCLUSIONS:There were no risk-adjusted differences in any 30-day postoperative complications between lymph node sampling criteria. These findings suggest that postoperative morbidity associated with lymph node sampling criteria may be less important than considering oncologic outcomes for optimizing quality of lymph node evaluation.

Treatment guidelines for non-small cell lung cancer (NSCLC) vary by several factors including pathological stage, patient candidacy, and goal of treatment. With many therapeutics and even more combinations available in the NSCLC clinician’s toolkit, a multitude of questions remain unanswered vis-a-vis treatment optimization. While some studies have begun exploring the interplay among the many pillars of NSCLC treatment—surgical resection, radiotherapy, chemotherapy, and immunotherapy—the vast number of combinations and permutations of different therapy modalities in addition to the modulation of each constituent therapy leaves much to be desired in a field that is otherwise rapidly evolving. Given NSCLC’s high incidence and lethality, the experimentation of synergistic benefits that combinatorial treatment may confer presents a ripe target for advancement and increased understanding without the cost and burden of novel drug development. This review introduces, synthesizes, and compares prominent NSCLC therapies, placing emphasis on the interplay among types of therapies and the synergistic benefits some combinatorial therapies have demonstrated over the past several years.

Introduction: Numerous studies across the world have characterized the effect of extreme heat exposure on cardiovascular health (CVH) using myriad data sources and methodologies. Here we review these studies and synthesize their methodological approaches and findings to identify common clinical factors associated with CVH following extreme heat exposure. Similarities and differences across the different global settings are identified and discussed. Hypothesis: CVH is modulated by the exacerbation of clinical cardiovascular health factors due to extreme heat, which will vary according to the study population’s climatological setting. Methods: Embase (Elsevier), MEDLINE (Ovid), Web of Science (Clarivate), and Scopus (Elsevier) were searched from date of inception until March 1, 2023 to locate English language literature on heat exposure in relation to cardiovascular vulnerability. Records were collated, deduplicated and screened. Eligibility for full text inclusion was determined as any article with a measured exposure of climate-related heat and an associated clinical outcome, thus excluding review papers and abstracts. Results: 13,136 records were initially identified of which 341 were determined eligible for full text review. 284 papers were excluded during full text review, yielding 57 papers for the final analysis representing 22 unique country study locations. 34 papers focused on CV-related mortality, 21 focused on CV-related morbidity, and 2 papers assessed both. The most common study type was observational (30), followed by case-crossover (18) and time series (5). A distributed lag non-linear model (DLNM) with a quasi-Poisson regression was the most common analytical methodology with usage in 19 studies. Studies done in Asia more frequently utilized the DLNM methodology while others used generalized additive models and conditional logistic regression. Lag patterns followed a “J” shape with the greatest risk for CVH following extreme heat events occurring at lag days 0-3 and lags 0-21. 97% (33/34) of mortality studies found a significant association with heat, with an excess risk of 6-80% for every 1°C above their respective extreme heat threshold, which was defined as the 99 th percentile of daily T mean in 32% (18/57) of papers. A greater risk of hospitalization and mortality for the elderly was reported across all studies, and women were found to be at greater risk than men for stroke (ischemic and hemorrhagic), circulatory disease, and mortality. The risk of myocardial infarction hospitalizations and MI-related mortality was inconsistent across studies. Conclusion: CVH is associated with extreme heat, with variations observed across different global environments. More work on this topic is crucial for informing public health policies and strategies aimed at reducing the burden of heat-induced cardiovascular vulnerability.

BACKGROUND Given resource constraints during the coronavirus disease 2019 pandemic, we explored whether minimally invasive anatomic lung resections for early-stage lung cancer could undergo rapid discharge. METHODS All patients with clinical stage I -II non-small cell lung cancer from September 2019 to June 2022 who underwent minimally invasive anatomic lung resection at a single institution were included. Patients discharged without a chest tube <18 hours after operation, meeting preset criteria, were considered rapid discharge. Demographics, comorbidities, operative details, and 30 -day outcomes were compared between rapid discharge patients and nonrapid discharge "control" patients. Multivariable logistic regression was performed for predictors of nonrapid discharge. RESULTS Overall, 430 patients underwent resection (200 lobectomies and 230 segmentectomies); 162 patients (37%) underwent rapid discharge and 268 patients (63%) were controls. The rapid discharge group was younger (66.5 vs 70.0 years; P < .001), was assigned to lower American Society of Anesthesiologists class (P = .02), had more segmentectomies than lobectomies (P = .003), and had smaller tumors (P < .001). There were no differences between groups in distance from home to hospital (P = .335) or readmission rates (P = .39). Increasing age had higher odds for nonrapid discharge (odds ratio, 1.04; 95% CI, 1.02-1.07), whereas segmentectomy had decreased odds (odds ratio, 0.46; 95% CI, 0.28-0.75). CONCLUSIONS Approximately 37% of the patients underwent rapid discharge after operation with similar readmission rate to controls. Increasing age had higher odds for nonrapid discharge; segmentectomy was likely to lead to rapid discharge. Consideration of rapid discharge minimally invasive lung resection for early-stage lung cancer can result in significant reduction in inpatient resources without adverse patient outcomes. (Ann Thorac Surg 2024;117:297-304) (c) 2024 by The Society of Thoracic Surgeons. Published by Elsevier Inc.

Background and Objectives: This study evaluates the prognostic value of venous tumor thrombus (VTT) in patients with advanced renal cell carcinoma (RCC) undergoing radical resection and inferior vena cava (IVC) thrombectomy. Methods: Retrospective review of patients with radical nephrectomy for RCC and associated VTT (2000-2024). Patients were dichotomized into Neves 0-II (infrahepatic) and Neves III-IV groups (suprahepatic) IVC involvement for univariate analysis. Results: A total of 64 patients (34 Neves 0-II and 30 Neves III-IV) were analyzed. No significant differences in patient or cancer characteristics. Neves III-IV was associated with greater blood loss (> 2 L) (62.1% vs. 37.9%, p = 0.02), greater intensive care unit length of stay (LOS) (4.4 vs. 1.4 days, p = 0.02), and postoperative LOS (11.0 vs. 6.5 days, p = 0.005). Overall, 30-day mortality was only 1.6% with a mean follow-up of 56.1 months. Local recurrence was 7.8% and IVC patency 96.9%. One-year survival was 82.0%, 5-year survival was 58.4%, and 15-year survival was 42.5% without significant difference between Neves levels. Conclusions: Radical nephrectomy with VTT thrombectomy and primary IVC repair is safe with high early survival and low local recurrence. Extent of IVC tumor thrombus extension is not a poor prognostic factor for early or late survival.

Background Minimally invasive esophagectomy is associated with decreased postoperative complications compared with open esophagectomy. However, the risks of complications for minimally invasive esophagectomy compared with open esophagectomy may be affected by operative time. The objectives of this study are to (1) compare the incidence of postoperative complications for minimally invasive esophagectomy and open esophagectomy and (2) evaluate the association of postoperative complications on operative approach and operative time. Methods A retrospective cohort analysis of patients who underwent an esophagectomy in the American College of Surgeons National Surgical Quality Improvement Program Procedure-Targeted Data File was performed from 2016 to 2020. For analysis, minimally invasive esophagectomy and open esophagectomy were stratified into tertiles of operative time. A bivariate analysis of postoperative complications comparing minimally invasive esophagectomy with open esophagectomy was performed. Multivariable Poisson regression models were estimated evaluating the association of the likelihood of postoperative complications with operative approach and operative time. Results In total, 8,574 patients who underwent esophagectomy were included: 5,369 patients underwent minimally invasive esophagectomy, and 3,205 patients underwent open esophagectomy. Median operative time was 402 minutes for minimally invasive esophagectomy and 321 minutes for open esophagectomy. The incidence of postoperative complications and 30-day mortality was lower in the minimally invasive esophagectomy group than the open esophagectomy group within the same tertiles of operative time. When we compared patients who underwent short open esophagectomy with those who underwent long minimally invasive esophagectomy, there were no significant differences in complications. Conclusion There is no significant association of postoperative complications for short open esophagectomy compared with long minimally invasive esophagectomy. Patients should be selected for minimally invasive esophagectomy when there is appropriate surgeon experience and hospital resources.

OBJECTIVE:To synthesize the methodologies of studies that evaluate the impacts of heat exposure on morbidity and mortality. METHODS:Embase, MEDLINE, Web of Science, and Scopus were searched from date of inception until 1 March 2023 for English language literature on heat exposure and health outcomes. Records were collated, deduplicated and screened, and full texts were reviewed for inclusion and data abstraction. Eligibility for inclusion was determined as any article with climate-related heat exposure and an associated morbidity/mortality outcome. RESULTS:Of 13,136 records initially identified, 237 articles were selected for analysis. The scope of research represented 43 countries, with most studies conducted in China (62), the USA (44), and Australia (16). Across all studies, there were 141 unique climate data sources, no standard threshold for extreme heat, and 200 unique health outcome data sources. The distributed lag non-linear model (DLNM) was the most common analytic method (48.1% of studies) and had high usage rates in China (68.9%) and the USA (31.8%); Australia frequently used conditional logistic regression (50%). Conditional logistic regression was most prevalent in case-control studies (5 of 8 studies, 62.5%) and in case-crossover studies (29 of 70, 41.4%). DLNMs were most common in time series studies (64 of 111, 57.7%) and ecological studies (13 of 20, 65.0%). CONCLUSIONS:This review underscores the heterogeneity of methods in heat impact studies across diverse settings and provides a resource for future researchers. Underrepresentation of certain countries, health outcomes, and limited data access were identified as potential barriers.

Electric vehicles (EVs) constitute just a fraction of the current U.S. transportation fleet; however, EV market-share is surging. EV adoption reduces on-road transportation greenhouse gas emissions by decoupling transportation services from petroleum, but impacts on air quality and public health depend on the nature and location of vehicle usage and electricity generation. Here, we use a regulatory-grade chemical transport model and an electricity dispatch algorithm to characterize neighborhood-scale (~1 km) air quality and public health benefits and tradeoffs associated with a multi-modal EV transition. We focus on a Chicago-centric regional domain wherein 30% of the on-road transportation fleet is instantaneously electrified and changes in on-road, refueling, and power plant emissions are considered. We find decreases in annual population-weighted domain mean NO2 (-11.84%) and PM2.5 (-2.56%) with concentration reductions of up to-5.1 ppb and-0.97 µg m-3 in urban cores. Conversely, annual population-weighted domain mean MDA8O3 concentrations increase +0.65%, with notable intra-urban changes of up to +2.3 ppb. Despite mixed pollutant concentration outcomes, we find overall positive public health outcomes, largely driven by NO2 decreases that produce mortality reductions that are ~5 times greater in census tracts with disproportionately large non-white populations.

Heavy-duty vehicles (HDVs) disproportionately contribute to the creation of air pollutants and emission of greenhouse gases—with marginalized populations unequally burdened by the impacts of each. Shifting to non-emitting technologies, such as electric HDVs (eHDVs), is underway; however, the associated air quality and health implications have not been resolved at equity-relevant scales. Here we use a neighbourhood-scale (~1 km) air quality model to evaluate air pollution, public health and equity implications of a 30% transition of predominantly diesel HDVs to eHDVs over the region surrounding North America’s largest freight hub, Chicago, IL. We find decreases in nitrogen dioxide (NO 2 ) and fine particulate matter (PM 2.5 ) concentrations but ozone (O 3 ) increases, particularly in urban settings. Over our simulation domain NO 2 and PM 2.5 reductions translate to ~590 (95% confidence interval (CI) 150–900) and ~70 (95% CI 20–110) avoided premature deaths per year, respectively, while O 3 increases add ~50 (95% CI 30–110) deaths per year. The largest pollutant and health benefits simulated are within communities with higher proportions of Black and Hispanic/Latino residents, highlighting the potential for eHDVs to reduce disproportionate and unjust air pollution and associated air-pollution attributable health burdens within historically marginalized populations.

US National Science Foundation, Ubben Program for Carbon and Climate Science, and Northwestern University.

Earth and Space Science Open Archive This preprint has been submitted to and is under consideration at Other. ESSOAr is a venue for early communication or feedback before peer review. Data may be preliminary.Learn more about preprints preprintOpen AccessYou are viewing the latest version by default [v1]Assessing Air Quality Co-Benefits and Tradeoffs of Sustainable Climate SolutionsAuthorsDanielHortoniDAnastasiaMontgomeryMaximeVisaGraceHauserJordanSchnelliDSee all authors Daniel HortoniDCorresponding Author• Submitting AuthorNorthwestern UniversityiDhttps://orcid.org/0000-0002-2065-4517view email addressThe email was not providedcopy email addressAnastasia MontgomeryNorthwestern Universityview email addressThe email was not providedcopy email addressMaxime VisaNorthwestern Universityview email addressThe email was not providedcopy email addressGrace HauserNorthwestern Universityview email addressThe email was not providedcopy email addressJordan SchnelliDCooperative Institute for Research in Environmental Sciences (CIRES), University of Colorado Boulder and NOAA ESRL Global Systems LaboratoryiDhttps://orcid.org/0000-0002-4072-4033view email addressThe email was not providedcopy email address