Non-Melanoma Skin Cancer Mortality in Spain: A Predictive Model up to 2044

Non-melanoma skin cancers (NMSC) are the most common malignancies worldwide and are, worryingly, increasing in incidence. However, data in the literature on NMSC specific mortality are scarce, because these tumors are excluded from most mortality registries. The main objective of this study is to analyze NMSC’s mortality rates and use them to generate a predictive model for the coming years in Spain. Data on mid-year population and death certificates for the period 1979–2019 were obtained from the Spanish National Statistics Institute. The Nordpred program (Cancer Registry of Norway, Oslo, Norway) within statistical program R was used to calculate mortality adjusted rates, as well as the mortality projection with an age-period-cohort model. This is the first study to report a prediction about NMSC mortality in the next years. According to our findings, the number of NMSC deaths in older people will grow in both sexes, especially in those older than >85 years old (y.o.). The age-specific mortality rates of NMSC will tend to stabilize or gradually decrease, with the exception of women between 75–79 y.o., who will present a slight increase at the end of the period. Early prevention and screening of NMSC specifically oriented to this population might change this tendency.

Mortality trends in chronic liver disease and cirrhosis from 1981 to 2015 in Taiwan

Background Globally, the morbidity and mortality rates for chronic liver disease and cirrhosis are increasing. The National Viral Hepatitis Therapy Program in Taiwan was implemented in 2003, but evidence regarding the program’s effect on the trends of mortality for chronic liver disease and cirrhosis is limited. Methods We analyzed mortality rates for chronic liver disease and cirrhosis in Taiwan for the period from 1981 to 2015. An autoregressive age–period–cohort model was used to estimate age, period, and cohort effects. Results Age-adjusted mortality rates for chronic liver disease and cirrhosis all displayed a flat but variable trend from 1981 to 2004 and a decreasing trend thereafter for both sexes. The age–period–cohort model revealed differential age gradients between the two sexes; mortality rates in the oldest age group (90–94 years) were 12 and 66 times higher than those in the youngest age group (30–34 years) for men and women, respectively. The period effects indicated that mortality rates declined after 2004 in both sexes. Mortality rates decreased in men but increased in women in the 1891–1940 birth cohorts and increased in both sexes in the birth cohorts from 1950 onward. Conclusions The National Viral Hepatitis Therapy Program in Taiwan may have contributed to the decrease in mortality rates for chronic liver disease and cirrhosis in adulthood.

Simulating approaches to emergency department pandemic physician staffing during COVID-19

Objective: During pandemics, emergency departments (EDs) are challenged by the need to replace quarantined ED staff and avoid staffing EDs with nonemergency medicine (EM) trained physicians. We sought to design and examine three feasible ED staffing models intended to safely schedule EM physicians to staff three EDs within a health system during a prolonged infectious disease outbreak.Methods: We conducted simulation analyses examining the strengths and limitations of three ED clinician staffing models: two-team and three-team fixed cohort, and three-team unfixed cohort. Each model was assessed with and without immunity, and by varying infection rates. We assumed a 12-week pandemic disaster requiring a 2-week quarantine.Main outcome: The outcome, time to staffing shortage, was defined as depletion of available physicians in both 8- and 12-hour shift duration scenarios. Results: All staffing models initially showed linear physician attrition with higher infection rates resulting in faster staffing shortages. The three-team fixed cohort model without immunity was not viable beyond 11 weeks. The three-team unfixed cohort model without immunity avoided staffing shortage for the duration of the pandemic up to an infection rate of 50 percent. The two-team model without immunity also avoided staffing shortage up to 30 percent infection rate. When accounting for immunity, all models behaved similarly initially but returned to adequate staffing during week 5 of the pandemic. Conclusions: Simulation analyses reveal fundamental tradeoffs that are critical to designing feasible pandemic disaster staffing models. Emergency physicians should test similar models based on local assumptions and capacity to ensure adequate staffing preparedness for prolonged pandemics.

Pathways to Critical Literacy Leadership: An Examination of a Cohort Model of Professional Development

As faculty at a land-grant university, we wanted to better understand the complexity of and pathways toward critical literacy leadership among educators. Specifically, we asked: What forms of critical literacy leadership become visible when educators participate in a cohort model of literacy professional development? Thirty educators enrolled across four different literacy cohorts at the university participated in this case study. Participants were diverse in their teaching experiences, racial identity, teaching placement, and literacy expertise. Participants shared similar geo-political-educational realities as they were all a part of the same large, urban district. Survey data, interviews, teaching and learning documents, and categorical data were analyzed in overlapping phases. Descriptive statistics were generated. Four themes related to critical literacy leadership surfaced from interviews using constant comparative methods: brokering equitable literacy practices, negotiating tensions, sharing/strengthening existing literacy practices, and imagining the futurity of literacy leadership. Educators offered complex portraits of critical literacy leadership in various spaces—often leading through learning. Participants’ voices highlighted the impact literacy leaders have on transformative, grassroots efforts toward change.

DATA LIMITED STOCK ASSESSMENT OF POPULATION DYNAMICS BY CMSY MODEL ON THE EXAMPLE OF BLACK SEA SPRAT IN THE RUSSIAN WATERS

This study performs approbation of trend CMSY model on the example of Black sea sprat fishing unit, localized in Russian waters. Data sources has been reduced to the level of data limited modeling for indicator and trend models approach. CMSY population model results were compared with previously performed estimations by more powerful cohort model - XSA. CMSY results shows no significant deviations from the XSA results. Forecast scenarios and conclusions based on CMSY model fitting leads to the same statements with previously published results by XSA. CMSY model shows next results: stock biomass in 2019 B2019 = 63,9 ths. t, fishing mortality – F2019 = 0,29. Stock biomass in 2019 was significant below the target reference point BMSY = 105 ths. t and higher then limit reference point Blim = 52,7 ths. t. Some uncertain overexploitation in 2019 was underlined, F2019/FMSY = 1,12. Investigation of forecast scenarios with different total allowed catch levels indicates that there are no features for increasing the catch capacity in short-term projection. CMSY model fitting have passed the necessary stability tests and confirm previously founded results. In summary of this study, we can recommend to use CMSY model for stock assessment procedure in terms of data-limited information background.

An analysis of cohort models in technical education at Kansas City Kansas Community College

This mixed method study was conducted to gain a better understanding of technical educational center (TEC) cohort programs at a midwestern urban community college. In a cohort model, the students start a program and progress through the curriculum together until completion (Bista and Cox, 2014). Specifically, the study focused on two student types, high school students who were taking college courses and postsecondary students as well as the TEC cohort faculty. The TEC cohort model was examined to learn more about the graduation rates, continued program enrollment, and student support systems. Due to a gap in the literature about cohort models in relationship to race, ethnicity, and gender, those aspects were also studied. The results of the study found that postsecondary students graduated at a higher rate than high school students. Relationships developed throughout the cohort among classmates and with the faculty were indicated as a contributing factor to program completion. Other themes included cohort model structure, hands-on learning, career opportunities, and student attitudes. The study concluded with a set of four recommendations.

Ensemble forecasting of a continuously decreasing trend in bladder cancer incidence in Taiwan

Bladder cancer is one of the most common malignancies involving the urinary system of about 1.65 million cases worldwide. To attain the 25 by 25 goal set by the World Health Organization (25% reduction in non-communicable diseases between 2015 and 2025), developing strategies to reduce cancer burdens is essential. The data of the study comprised the age-specific bladder cancer cases and total population numbers from age 25 to 85 and above from 1997 to 2016 in Taiwan. An ensemble age–period–cohort model was used to estimate bladder cancer incidence trends and forecast the trends to 2025. For men, the projected age-standardized incidence rates per 100,000 people in 2020 and 2025 are 13.0 and 10.4, respectively, with a 16.1% and 32.9% decrease projected from 2016 to 2020 and 2025, respectively. For women, the projected age-standardized incidence rates per 100,000 people in 2020 and 2025 are 4.7 and 3.7, respectively, with a 16.1% and 33.9% decrease projected from 2016 to 2020 and 2025, respectively. The age-specific bladder cancer incidence rates demonstrated a consistently downward trend after 2003 for all ages and both sexes. This study projects that the incidence rates of bladder cancer in Taiwan will continue to decrease, and more than a 25% reduction can be achieved from 2016 to 2025.

Impact and cost-effectiveness of potential interventions against infant respiratory syncytial virus (RSV) in 131 low-income and middle-income countries using a static cohort model

ObjectivesInterventions to prevent childhood respiratory syncytial virus (RSV) disease are limited and costly. New interventions are in advanced stages of development and could be available soon. This study aims to evaluate the potential impact and cost-effectiveness of two interventions to prevent childhood RSV—a maternal vaccine and a monoclonal antibody (mAb).DesignUsing a static population-based cohort model, we evaluate impact and cost-effectiveness of RSV interventions, from a health systems perspective. The assumed baseline efficacy and duration of protection were higher for the mAb (60%–70% efficacy, protection 6 months) compared with the maternal vaccine (40%–60% efficacy, protection 3 months). Both interventions were evaluated at US$3 and US$5 per dose for Gavi and non-Gavi countries, respectively. A range of input values were considered to explore uncertainty.Settings131 low-income and middle-income countries.ParticipantsPregnant women and live birth cohorts.InterventionsMaternal vaccine given to pregnant women and mAb given to young infants.Primary and secondary outcome measuresDisability-adjusted life years averted, severe case averted, deaths averted, incremental cost effectiveness ratios.ResultsUnder baseline assumptions, maternal vaccine and mAbs were projected to avert 25% and 55% of RSV-related deaths among infants younger than 6 months of age, respectively. The average incremental cost-effectiveness ratio per disability-adjusted life year averted was US$1342 (range US$800–US$1866) for maternal RSV vaccine and US$431 (range US$167–US$692) for mAbs. At a 50% gross domestic product per capita threshold, maternal vaccine and mAbs were cost-effective in 60 and 118 countries, respectively.ConclusionsBoth interventions are projected to be impactful and cost-effective in many countries, a finding that would be enhanced if country-specific Gavi cofinancing to eligible countries were included. mAbs, with assumed higher efficacy and duration of protection, are expected to be more cost-effective than RSV maternal vaccines at similar prices. Final product characteristics will influence this finding.