Purpose:To describe the use of a model eye-mounted retinal phantom to support adaptive optics scanning light ophthalmoscope (AOSLO) imaging in a multicenter clinical trial (NCT05537220). Methods:Six three-dimensional-printed retinal phantoms were mounted in model eyes. These phantoms contain equally spaced arrays of reflective "cone-like" structures mimicking foveal cone photoreceptor spacing. Intrasession repeatability of phantom imaging was assessed for all six phantoms on two custom AOSLOs. One phantom was also imaged on two additional AOSLOs to assess interdevice reproducibility. Lastly, each of the six phantoms was imaged longitudinally at their respective trial sites. Results:Intrasession repeatability of phantom-derived horizontal "cone" spacing measures was high for two different AOSLOs. However, intersystem differences were found in the average horizontal "cone" spacing of five of eight patches assessed. Across four unique AOSLOs, intersystem differences were found in the average horizontal "cone" spacing of seven of eight patches assessed. A linear regression analysis of longitudinal phantom imaging with a single AOSLO revealed few significant changes in horizontal "cone" spacing over the course of about 2 years. Similar results were observed for vertical "cone" spacing measures across the three experiments. Conclusions:Longitudinal spacing measurements were generally stable in our study. However, small but significant differences in spacing were observed between systems. The approach described here may facilitate combining cone metrics extracted from images acquired using different AOSLOs in multicenter studies. Translational Relevance:Cross-system validation strategies can support the use of AOSLO imaging in multicenter clinical trials.

Improving patient experiences and outcomes of traumatic brain injury (TBI) will require understanding patient perspectives of current care systems. Experts have called for building more integrated, patient-centered systems of care to better support patients through stages of TBI recovery. Informed by an earlier qualitative study, we conducted a survey to quantify patient perspectives on discharge and post-discharge experiences across seven hospitals in a single southeastern Wisconsin health system. Eligible participants were English or Spanish speakers and received TBI care between February 2023 and June 2024 at one level I trauma center emergency department (ED) and inpatient unit, two level III trauma center EDs, or four freestanding (non-hospital-based) EDs. Of N = 1,085 patients invited, 321 responded to questions about awareness of TBI diagnosis, discharge instructions, post-discharge treatment experiences, and gaps in follow-up care. Fifty percent of respondents were male, with a median age of 44 years, and 94% were English speakers. Weighted results indicated that 35% of participants were unaware of their TBI diagnosis, 39% desired more follow-up care, and 50% reported still experiencing injury-related symptoms at the time of the survey (Median 94 days [interquartile range 53, 149]). Sociodemographic factors were also associated with some study outcomes: Individuals who were Spanish-speaking reported lower awareness of their TBI diagnosis compared with English speakers (9% vs. 67%, p = 0.001). Additionally, individuals in the highest quartile of neighborhood disadvantage were more likely to desire follow-up care (66%) compared to those in lower disadvantage quartiles (26%-31%; p > 0.001). Moreover, survey outcomes were associated in important ways. For instance, the receipt of a TBI-related handout at discharge was associated with greater awareness of TBI diagnosis (p = 0.003) and better understanding of home care instructions (p < 0.001). Our findings emphasize the urgent need to strengthen follow-up pathways and deliver more patient-centered care that prioritizes effective patient-provider communication, particularly around diagnosis and the provision of TBI discharge education.

Background The SMILE study is a multi-institutional phase II clinical trial to determine the efficacy and safety of an antiprogestin, onapristone, in combination with fulvestrant as second-line therapy for patients with ER+, PgR+/-, HER2- metastatic breast cancer. This study was terminated early and herein, we report patient characteristics, and outcomes. Methods Eligibility criteria included disease progression on >= 2 lines of prior therapy, ECOG performance status <= 2, measurable disease per RECIST 1.1 criteria, and optional F-18-fluorofuranylnorprogesterone (F-18-FFNP) PET/CT imaging. Results Consented subjects received standard-dose fulvestrant plus onapristone 50 mg orally, twice daily, until disease progression, or unacceptable toxicity. The study enrolled 11 women from 2 sites within the Wisconsin Oncology Network from November 2021 through March 2023. Mean age of the subjects was 58.5 years. Other than grade 1 toxicities, the treatment was well tolerated. None of the 11 subjects met RECIST 1.1 definition of response. The median time to progression was 63 days. A total of 4 of 11 patients had stable disease as best response and 2 of them were on treatment for 5.5 and 7.7 months. Two of the 11 subjects underwent functional imaging with F-18-FFNP PET/CT before and 10 or 14 days after starting treatment. For both subjects, tumor uptake of F-18-FFNP was stable or increased in all target lesions while F-18-FFNP uptake in the uterus, a normal PgR-rich internal control organ, was decreased. Conclusion The study regimen was well-tolerated with no significant toxicities. Future studies may evaluate antiprogestins with various combinations such as targeted therapies. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Structural racism may be associated with disparities in breast cancer access to care and outcomes. We examined the association between contemporary mortgage lending bias (redlining) and the receipt of guideline-concordant systemic treatment. Women with stage I–III invasive breast cancer in 2010–2017 were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database. Contemporary redlining was estimated using 2010–2017 Home Mortgage Disclosure Act data. Simple and multiple logistic regression models estimated the unadjusted and adjusted odds of receiving guideline-concordant systemic treatment: appropriate receipt of chemotherapy, HER2/neu (HER2)-targeted therapy, hormonal therapy, and a composite systemic treatment measure. Overall compliance rates were 85

It has been well recognized that not only biomarkers but also their variability are important for predicting biomarker-related diseases. Understanding and adequately modeling the variability of biomarkers is crucial for detecting and predicting health risks, leading to improved health outcomes and patient care. However, biomarker variability modeling comes with a high computational cost, as statistical models incorporating biomarkers’ variability rely on double integrals with two nested integrations, which must be repeatedly calculated during modeling. To reduce the computational burden, we propose a novel approach aligned with arc length in mathematics to approximate and model biomarker fluctuations. Furthermore, we propose an algorithm that aligns with fast arc length evaluations for the joint modeling of survival and longitudinal data. We synthesize multiple efficient computing methods into a unified framework to accelerate the entire computational process. The core component of the acceleration is the computational efficiency of the double integrals, even when the iterated integral representation of the double integral is not possible. Finally, we illustrate the usage and benefit of our algorithm in joint models in numerical examples and the primary biliary cholangitis clinical study.

Purpose:Individuals poststroke with severe hemiparesis and deconditioning may have physical difficulty walking fast and/or long enough to perform vigorous cardiovascular intensity during locomotor high-intensity interval training (HIIT). We hypothesized that baseline walking function would be associated with the average percent heart rate reserve (%HRR) performed during locomotor HIIT. Methods:Baseline assessments included walking endurance (6-min walk test), comfortable and fast walking speed (10-m walk), step length and single-limb support symmetry (electronic walkway), and metabolic cost of fast walking (ml O2/kg/m during a graded maximal exercise test). Covariates included peak heart rate (HRpeak) and respiratory exchange ratio (RER) achieved during the graded maximal exercise test and baseline self-reported fatigue (PROMIS fatigue scale). To reduce bias, %HRR was examined during treadmill HIIT, consisting of 20 minutes of repetitive 30 seconds of maximal walking speed separated by 30 to 60 seconds of standing passive recovery, performed 3×/week. Results:Twenty-seven individuals were allocated to HIIT (age 63 ± 10 years, 2.7 ± 1.4 years poststroke). Less baseline walking step length symmetry ( β ^ = - 0.28 , P = .03) and less baseline fatigue poststroke ( β ^ = - 0.86 , P = .02) were associated with a higher cardiovascular intensity achieved during the first week of locomotor HIIT. Across 12 weeks of HIT, baseline factors were no longer associated with %HRR. Conclusion:Few baseline walking characteristics were associated with cardiovascular intensity during the initiation of locomotor HIIT, potentially because of large variability in the heart rate response. As individuals progressed over time and were able to reach higher cardiovascular intensity, the associations were abrogated.

Background Cardiovascular (CV) disease (CVD) remains a significant concern among breast cancer (BC) survivors, particularly following potentially cardiotoxic treatments, such as anthracyclines and anti-HER2 drugs, which increase the risk of major adverse CV events (MACE). Social determinants of health (SDOH) and environmental factors influence health outcomes, including those related to CVD. Urban greenspace has been associated with CV and cancer-related health benefits, yet its specific impact on MACE among BC survivors remains unknown. Objective This study aims to investigate the association between urban greenspace and time to first MACE incidence among individuals with BC after being treated with cardiotoxic therapies in the greater Milwaukee, WI area. Methods A retrospective cohort study was conducted using electronic medical records from the Froedtert Health System, linked to the National Death Index. Cox proportional hazards regression models were used to assess the association between percent tree canopy cover and MACE-specific hazards, adjusting for sociodemographic, clinical, and neighborhood-level factors. Results Among the 849 women included, 44.6 % experienced a MACE. Adjusted models indicated an 18 % reduction in MACE-specific hazard (HR: 0.82, 95 % CI: 0.70, 0.96) and a 20 % reduction in MACE-specific hazard (HR: 0.80, 95 % CI: 0.67, 0.97) for women in the second and third quartiles of percent tree canopy cover, respectively, compared to the women in the first (lowest) quartile. However, we did not observe a risk difference for women living in the fourth quartile of tree canopy. Racial/ethnic disparities in greenspace exposure and MACE incidence were evident, with Non-Hispanic Black (NHB) women having a lower proportion living in areas with the highest tree canopy cover and a higher MACE incidence (61.9 %) compared to Non-Hispanic White (NHW) women (41.6 %), who had the highest proportion residing in areas within the 4th quartile of tree canopy cover. Discussion Our findings suggest that urban tree canopy is associated with time to incident MACE among BC survivors receiving cardiotoxic treatments. These results underscore the importance of considering socioenvironmental factors in CardioOncology care and highlight the benefits of greenspace in mitigating CV complications among individuals with BC. Future research should delve into individual lifestyle and behavioral factors, environmental factors, and biological mechanisms that may underlie these associations. Additionally, longitudinal studies should be conducted to evaluate greenspace-based interventions for BC survivors, aiming to advance precision CardioOncology interventions. Observed racial/ethnic disparities in MACE incidence underscore the urgent need for equity-focused interventions addressing greenspace access and MACE-related disparities.

Purpose:To assess longitudinal changes in parafoveal cone density in individuals with congenital achromatopsia (ACHM). Design:Retrospective longitudinal study. Participants:Nineteen individuals (7 women and 12 men) with genetically confirmed ACHM. To be eligible, each had adaptive optics scanning light ophthalmoscope (AOSLO) images of the photoreceptor mosaic from ≥2 time points. Methods:For each individual, follow-up AOSLO montages were aligned to their baseline montage. Notably, 100 × 100 μm regions of interest (ROIs) were extracted from the split-detection modality at locations 1°, 5°, and 10° temporal (T) from the peak cone density in each montage. All ROIs from follow-up visits were then manually aligned to their respective baseline ROI for that location. Cones were identified in each ROI by one observer, reviewed by a second observer, and confirmed together in a masked fashion. Cone density was calculated, and a linear mixed model was used to assess changes in density over time. A Wald test was performed to determine if the cone density changes were statistically significant. Main Outcome Measures:Parafoveal cone spacing (at 1°, 5°, and 10° T) as a function of time. Results:The mean (± standard deviation [SD]) age at baseline was 21.6 ± 10.7 years and the mean (±SD) follow-up period was 3.83 ± 2.93 years (range, 0.46-8.66 years). At 1° T, we observed a significant decrease of 352 cones/mm2 per year (P = 0.0003). At 5° T, the linear mixed model showed a nonstatistically significant decrease of 58 cones/mm2 per year (P = 0.504). At 10° T, we observed a significant decrease of 139 cones/mm2 per year (P = 0.0188). For a 100 × 100 μm ROI, these density changes correspond to a reduction of between about 0.5 and 4 cones per year, depending on the location. Conclusions:Parafoveal cone density estimates in ACHM show a small decrease over time. These observed changes are within the previously reported longitudinal repeatability values for normal retinas, suggesting the observed average cone loss may not be clinically meaningful. Further studies with longer follow-up times and more genetically heterogeneous and age-diverse populations are needed to better understand factors contributing to changes in foveal and parafoveal cone structure in ACHM over time. Financial Disclosures:Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.

BACKGROUND Breast cancer (BC) is the most frequently diagnosed cancer among women in the United States. Cardiovascular disease (CVD) is a major noncancer cause of death among BC survivors. Although greenspace is linked to better CVD and BC-related outcomes, its effect on BC survival is unknown. OBJECTIVES This study investigates the association between urban greenspace and survival among older BC survivors in the United States and examines regional differences. METHODS Data from the 2010 to 2017 Surveillance, Epidemiology, and End Results-Medicare BC cohort was used. Women aged 66+ with invasive BC, enrolled in Medicare (Parts A and B) for 12 months prediagnosis and with known tract-level greenspace data (N = 86,300) were included. Greenspace was measured as census tract percent tree canopy quartiles. Survival outcomes included all-cause mortality (ACM), BC-specific mortality (BCSM), and CVD-specific mortality (CVDSM), with censoring by December 31, 2018. Covariates included age, comorbidity, race/ethnicity, Medicaid eligibility, tumor stage and subtype, neighborhood social vulnerability, and population density. RESULTS Of 86,300 women, 22,541 (26.1%) died during the follow-up, 9,012 (40.6%) and 4,195 (18.9%) died from BC and CVD, respectively. Greater percent tree canopy was associated with lower ACM (HR: 0.90; 95% CI: 0.86-0.95) and BCSM (cause-specific HR: 0.90; 95% CI: 0.82-0.98). Regional variations were observed, with greenspace linked to lower ACM in California, New Jersey, and Michigan, and lower BCSM and CVDSM in California and New Jersey. Washington, Louisiana, and Georgia showed nonsignificant or inconsistent results. CONCLUSIONS This study highlights the importance of investigating the relationship between greenspace and cardiooncology-related outcomes across regions, underscoring the need for more place-specific research to guide targeted interventions to improve survival outcomes. (JACC Adv. 2025;4:102069) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

There are limited data directly comparing recovery across traumatic brain injury subpopulations. We compared symptom recovery profiles between patients with Glasgow Coma Scale (GCS) 13-15 traumatic brain injury (TBI) from the same region in three cohorts: (1) Participants with sport-related concussion (SRC), (2) participants evaluated and discharged from the level 1 trauma center emergency department (ED), and (3) participants who required 1 + night(s) in the inpatient unit (IP). The current analysis aggregates data from two prospective cohort studies at the same institution resulting in a combined dataset of 395 patients with TBI (224 with SRC, 95 discharged from the ED, and 75 admitted [IP]). The primary outcome measure of interest was self-reported TBI symptom duration (in days). Two multivariable Cox proportional hazards models evaluated differences in symptom recovery between groups while controlling for recovery risk factors, including age, sex, race/ethnicity, acute symptom severity, psychological disorder history, loss of consciousness, and post-traumatic amnesia. The second model included only ED and IP, due to availability of additional predictor variables in these samples (e.g., education, cause of injury, peripheral injury severity). In unadjusted models, hazards of symptom recovery were lower with increasing levels of care (IP vs. ED HR=.40, p < .001; IP vs. SRC HR=.11, p < .001, ED vs. SRC HR=.28, p < .001). Controlling for covariates, longer symptom recovery in the trauma center subsamples versus SRC persisted (IP vs. SRC HR=.26, p = .018, ED vs. SRC HR=.52, p = .021), whereas differences between ED and IP became nonsignificant (HR=.86, p = .782). Acute symptom severity (HR=0.98; p < 0.001-0.010) and psychiatric history (HR=0.27-0.36; p ≤ 0.034) were independent predictors of symptom duration in both models. The results of this study suggest that patients with TBI and GCS 13-15 seen at a level 1 trauma center vary significantly in symptom recovery and severity in comparison to those with SRC, regardless of population differences in age, sex and psychiatric history.

Single passive limb movement (sPLM) of the lower extremity is a simple and clinically relevant measure of the microvascular vasodilatory response to movement. A promising stimulus to improve microvascular health is ischemic conditioning (IC). We examined whether a single session of IC could improve microvascular reactivity to sPLM in young adults. This was a blinded, crossover, randomized clinical trial. Participants were seated in an isokinetic dynamometer that passively moved the knee 90° at a frequency of 1 Hz while superficial femoral artery leg blood flow (LBF) was measured. The absolute and the relative peak changes in LBF were calculated as the difference from baseline. The time to peak was calculated from the start of sPLM to peak LBF. The total area under the curve (AUC) was the sum of LBF above baseline during the hyperemic response. For IC, the cuff was placed around the dominant thigh and repetitively inflated (225 mmHg) for 5 min, then deflated for 5 min (total 45 min). For sham IC, the cuff was inflated to 25 mmHg. The sPLM response was re-assessed ten minutes after IC. Twelve individuals completed the study (age 27 ± 3 years, 50

PURPOSE:To help patients make better-informed health care decisions and decrease overall health care expenditures, the Centers for Medicare and Medicaid Services established a price transparency law in 2021 requiring hospitals to publish price data. We investigated hospital compliance rates with price reporting, price variation for common hand surgery procedures, and the influence of hospital factors on price. METHODS:Common Procedure Terminology (CPT) codes for 14 common hand procedures were searched in the Turquoise Health database for prices published by hospitals nationwide from March 2023 to August 2023. Hospital details were collected, and univariate and multivariable analyses assessed the relationship between hospital factors and price for each CPT code. RESULTS:A total of 769,349 contracted rates from 3,700 different hospitals were analyzed from 14 hand surgery CPT codes. The greatest price variation was seen with surgical treatment for Dupuytren disease, and the smallest price variation was seen with lesion excision. Multivariable analysis of hospital factors demonstrated geographic region, private ownership, and safety net status most affected price, whereas Medicare's hospital rating, status as an academic center, hospital bed size, and compliance with the price transparency law did not consistently influence price. Higher prices were found for hospitals in the Northwest and West regions, privately owned health care institutions, nonsafety net hospitals, and hospitals in urban settings. CONCLUSIONS:Since Centers for Medicare and Medicaid Services legislation enactment, there is continued variation in price transparency and cost of common hand surgery procedures, regardless of hospital ranking. CLINICAL RELEVANCE:The lack of transparency may place patients at a disadvantage, particularly when seeking a physician and hospital system for elective surgeries.

Background and purpose: Quantitative MRI (qMRI) has been explored for detecting tumor changes during radiation therapy (RT) in head and neck squamous cell cancer (HNSCC). Clinical trials show prolonged survival with PD-1 targeted immune checkpoint inhibition. Hypofractionated radiation regimens are being studied to counteract radioresistant clonogen formation. This study aims to use daily qMRI monitoring in these therapies. The objective of this exploratory study was to investigate if qMRI can detect tumor microenvironment changes during hypofractionated RT in a phase I trial of Dose-Escalated Hypofractionated Adaptive Radiotherapy (DEHART). Materials and methods: Seventeen subjects with advanced HNSCC underwent MR-guided RT with daily qMRI using a 15-fraction regimen to a cumulative dose of 50, 55, or 60 Gy. A 1.5 T MRI-Linac collected daily intravoxel incoherent motion (IVIM), T1, and T2 mappings. Median primary tumor ADC, D, D*, f, T1, and T2 were calculated, using paraspinal muscle as a control. qMRI parameters were analyzed by treatment condition and length using linear mixed effect models and nonparametric tests. Results: Significant (p < 0.05) increases in ADC, D, f, and T2 were observed over treatment duration for multiple conditions. Daily monitoring enhanced result significance compared to weekly collection. Conclusions: Daily qMRI effectively monitors tumor response over short periods and varying treatment conditions. Further studies on radiation and systemic therapy combinations in HNSCC could benefit from daily qMRI data collection.

Manual wheelchair mobility places high demands on the upper extremity, often leading to shoulder pain and injuries. Despite existing clinical practice guidelines for upper limb preservation following spinal cord injury/dysfunction (SCI/D), most still experience shoulder pain. These guidelines are applied to children with SCI/D without sufficient evidence of effectiveness over their lifespan. Individuals with pediatric-onset SCI/D live longer with secondary health conditions than those with adult-onset SCI, making it crucial to understand the relationship between shoulder function, pain, and pathology across ages. We are therefore investigating the relationship between pediatric-onset and adult-onset SCI/D manual wheelchair propulsion and their association with shoulder pain and pathology. Together our team is exploring innovative, transdisciplinary strategies to enhance shoulder health and function, leveraging insights from engineering, physiatry, radiology, behavioral science, and data analytics. We are working together to conduct a mixed-methods study integrating quantitative assessments of shoulder function and rotator cuff integrity, and qualitative insights from individuals with SCI/D. Our team is also determining the effects of age at onset and movement variability on rotator cuff and bony forces using personalized musculoskeletal simulations. Results suggest age of onset significantly affects shoulder dynamics and tendon integrity with decreased variability linked to increased shoulder pain and pathology. These findings will ultimately be used to develop age-appropriate rehabilitation guidelines, improving functional independence, participation, and quality of life for individuals with SCI/D. Our transdisciplinary approach is crucial for solving the multifactorial issue of alleviating shoulder dysfunction in manual wheelchair users across the lifespan to develop lasting rehabilitation impacts.

OBJECTIVES:To determine whether preoperative use of tamsulosin is associated with hypotension during cardiopulmonary bypass (CPB) surgery. DESIGN:Retrospective observational cohort design. SETTING:A tertiary referral hospital. PARTICIPANTS:159 male patients, 40-90 years old, who underwent coronary artery bypass graft or valve replacement surgery at the authors' hospital from April 1, 2021 to May 31, 2022. INTERVENTIONS:Preoperative use of tamsulosin in male patients undergoing coronary artery bypass graft or valve replacement surgery. MEASUREMENTS AND MAIN RESULTS:Groups were based on preoperative tamsulosin use: tamsulosin use within 24 hours before bypass (n = 41) versus no tamsulosin use before surgery (n = 118). The primary outcome was vasopressor use in 30-minute time periods during CPB and upon arrival in the intensive care unit (ICU). Unadjusted and adjusted linear mixed-effects models were used to examine vasopressor use over time and across groups. The unadjusted model showed that preoperative tamsulosin users required significantly greater vasopressor support during all bypass time periods (all p ≤ 0.006) and upon ICU arrival (p = 0.014) than did the no tamsulosin group. An effect of preoperative tamsulosin remained after adjusting for risk factors associated with vasoplegia. Compared with nonusers, the tamsulosin group required significantly greater vasopressor support across all bypass time periods (p < 0.001-0.033). CONCLUSIONS:This study suggests that the use of tamsulosin prior to cardiac surgery is associated with an increased requirement for vasoactive support during CPB and upon ICU arrival. Prospective studies are warranted.

PURPOSE:Rural compared to urban populations have higher age-adjusted injury mortality rates. We sought to describe differences in traumatic injury mechanisms, severity, and mortality in Wisconsin adults in rural and urban areas. METHODS:State trauma registry data were analyzed for adult patients injured in 2021-2022. The Wisconsin Health Innovation Program's rural and urban classification scheme, consisting of urban advantaged, urban, urban underserved, rural advantaged, rural, and rural underserved groups, was used. Multivariable logistic regression models for in-hospital injury mortality and prolonged length of stay (LOS) were developed. FINDINGS:Overall, 47,460 patients were included; 14.3% in rural, 9.5% in rural advantaged, 4.1% in rural underserved areas, 35.4% in urban, 22.0% in urban advantaged, and 14.8% in urban underserved areas. Firearm and pedestrian injuries were more common in urban areas, and motor vehicle/transportation injuries were common in rural areas. Lower odds of prolonged LOS were observed in those residing in rural advantaged (OR = 0.70, 95%CI: 0.55-0.90; p = 0.004), rural (OR = 0.66, 95%CI: 0.53-0.82; p < 0.001), and rural underserved (OR = 0.64, 95%CI: 0.50-0.82; p < 0.001) compared to urban advantaged areas. Those in rural underserved areas had higher odds of in-hospital mortality (OR = 1.48, 95%CI: 1.15-1.91; p = 0.003) compared to urban advantaged areas. CONCLUSIONS:Patients in rural Wisconsin experienced different injury mechanisms than in urban areas. Those in urban areas were more likely to have a prolonged hospital LOS, but those in rural underserved areas had higher in-hospital mortality. Rural populations may benefit from injury prevention specific to the mechanisms of injury in that area and resource allocation to enhance trauma services.

Objective:To investigate the association between urban residential greenspace and cardiovascular disease (CVD) comorbidity at breast cancer (BC) diagnosis among older women, and explore regional, racial/ethnic, and socioeconomic differences. Study design:This is a cross-sectional analysis of a population-based registry data. Methods:Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, data on women aged 66-90 diagnosed with BC (2010-2017) were analyzed. A tract-level measure of tree canopy cover was derived from the National Landcover Database (2011) and linked to SEER-Medicare records. Logistic regression models assessed the probability of CVD comorbidity based on state-specific percent tree canopy quartiles, adjusting for census tract clustering and covariates. Results:Out of 116,660 women, 74.7% (n=87,152) had CVD comorbidity at BC diagnosis. Overall, women residing in areas with higher percent tree canopy cover had a lower likelihood of CVD comorbidity compared to those in the lowest canopy areas, with an Adjusted Odds Ratio (AOR) and 95% confidence interval (CI) of 0.78 (0.71-0.85). Racial/ethnic, socioeconomic status (SES), and regional variations were noted. Adjusted effects of greenspace were significant only for NHW women; AOR (95%CI) = 0.78 (0.71-0.86). Women in the highest tree canopy quartile in California, New Jersey, and New Mexico had lower odds of comorbid CVD, with AORs (95% CI) of 0.80 (0.72-0.88), 0.77 (0.71-0.84), and 0.46 (0.34-0.63) respectively. Adjusted results for New York, Massachusetts, and Kentucky showed adverse harmful effects, while adjusted results for all other SEER states were not statistically significant. Both dual enrollment eligible and non-eligible women had benefits from greenspace, but greater benefits were observed in dual enrollment eligible women; AOR (95% CI)= 0.64 (0.48-0.86) versus 0.76 (0.69-0.84) for non-eligible women. Conclusions:Overall, urban greenspace is associated with a lower risk of CVD comorbidity among older women with BC, and variations exist by region, race/ethnicity, and SES. Our findings underscore the role of greenspace in mitigating Cardio-Oncology disparities. Further research is needed to better understand factors contributing to observed differences across SEER regions and racial/ethnic subgroups. A better understanding of interactions among greenspace, other environmental factors, and individual lifestyle factors will help improve CVD outcomes among women with BC.

When individuals present with hand injuries, clinicians often use the contralateral hand as an internal control. However, subtle differences in baseline dexterous abilities between the dominant and nondominant hands are poorly understood. To address this gap, here we quantified such differences, measured as independence (individuation) and smoothness of finger movements. A cohort of 47 right-hand-dominant healthy adults (22 males and 25 females) moved each finger independently 10 times, while joint angle data were tracked with a dataglove (CyberGlove III, CyberGlove Systems, San Jose, CA). Each finger's performance was compared with its counterpart on the opposite hand using Wilcoxon-signed rank tests. The right hand scored significantly higher than the left on both direct comparison and linear mixed-effect modeling for thumb individuation (P < 0.0001) and smoothness (P < 0.0001), index finger individuation (P = 0.012), and middle finger individuation (P = 0.009). Differences between the hands for index and middle finger individuation scores changed depending on the individuation scoring method used. Sex-based comparisons revealed females had greater asymmetry of thumb (P = 0.044) and ring finger (P = 0.020) individuation scores, as well as ring finger smoothness (P = 0.036) compared with males on both direct comparison and multiple linear regression. Cluster and principal components analysis were performed to detect whole hand differences. Dominant and nondominant hands were separated using smoothness metrics at a 74.5% sensitivity, 66% specificity, 68.6% positive predictive value, and 72.1% negative predictive value. In sum, this represents the largest study to date quantifying naturally occurring differences in hand dexterity between dominant and nondominant hands in healthy, right-handed young adults.NEW & NOTEWORTHY Here we present the largest study to date quantifying differences in finger dexterity between the dominant and nondominant hands in healthy, right-hand-dominant, young adults using finger individuation and smoothness. To our knowledge, we are the first to demonstrate differences between dominant and nondominant thumb, index, and middle finger dexterity metrics. Whole hand analyses indicate the dominant and nondominant hands can be separated based on smoothness with above-chance sensitivity and specificity.

Abstract Standard of care treatment for virtually all glioma subtypes starts with maximal safe resection. However, resections that result in motor deficits can negate any survival benefit from surgery and diminish quality of life. Because current evidence on functional outcomes following glioma resection often conflicts and is limited to a small number of case series, retrospective analyses, and reviews, here we performed the first PRISMA-compliant systematic review and meta-analysis of currently published data to identify factors related to permanent and temporary motor deficits after surgery. We searched Ovid Medline, Scopus, Web of Science, CINAHL/EBSCO, PsychInfo, Cochrane and Wiley for studies reporting motor outcomes following surgical resection of glioma. Outcomes were stratified by patient/tumor characteristics, pre-operative condition, and intra-operative factors for both permanent (≥3 months postop) and temporary (<3 months postop) motor deficits. Generalized estimating equations were used to generate odds ratios and 95% confidence intervals. A total of 1,162 titles and abstracts were reviewed for eligibility resulting in the evaluation of 211 full-text articles. Data were extracted from 55 studies including 1,801 patients with 223 (12%) permanent postoperative motor deficits, 428 (24%) temporary motor deficits, and the remaining 1,150 (64%) without motor deficit. Pre-operative deficit was the strongest predictor of permanent post-operative motor deficit (OR 10.56, CI 5.20-21.45, p=7.2E-11), while high pre-operative Karnofsky Performance Scale (KPS) (OR 0.98, CI 0.97-0.99, p=0.036) and subcortical tumor location (OR 0.15, CI 0.025-0.90, p=0.038) were associated with no permanent deficit. Supratotal resection was significantly associated with temporary motor deficits (OR 3.54E+12, CI 3.53+E13-3.56E+17, p<2E-16), and asleep craniotomies were associated with no deficit (OR 1.68E-01, CI 4.93E-02–5.71E-01, p=0.0043). Ultimately, this study represents the largest analysis of motor outcome data in glioma surgery to date.