BACKGROUND.Differences in cancer survival based on race, ethnicity, and socioeconomic status (SES) are a major issue. To identify points of intervention and improve survival, the authors sought to determine the impact of race, ethnicity, and socioeconomic status for patients with cancers of the head and neck (HN).METHODS.HN cancer patients diagnosed between 1998 and 2002 were examined using a linked Florida Cancer Data System and Florida Agency for Health Care Administration data set.RESULTS.A total of 20,915 patients with HN cancers were identified, predominantly in the oral cavity and larynx. Overall, 72% of patients were male, 89.7% were white, 8.4% were African American (AA), and 10.6% were Hispanic. The median survival time (MST) was 37 months. MST varied significantly by race (white, 40 months vs AA, 21 months; P < .001), sex (men, 36 months vs women, 41 months; P = .001), and area poverty level (lowest, 27 months vs highest, 34 months; P < .0001). Only 32% of AA patients underwent surgery in comparison with 45% of white patients (P < .001). On multivariate analysis, independent predictors of poorer outcomes were race, poverty, age, sex, tumor site, stage, grade, treatment modality, and a history of smoking and alcohol consumption.CONCLUSIONS.Carcinomas of the HN have an overall high mortality with a disproportionate impact on AA patients and the poor. Dramatic disparities by race and SES are not explained completely by demographics, comorbid conditions, or undertreatment. Earlier diagnosis and greater access to surgery and adjuvant therapies in these patients would likely yield significant improvement in outcomes. Cancer 2008. © 2008 American Cancer Society.

We describe the role of leaf-litter ants (Pheido/e spp.) in the seed bank dynamics of several small-seeded shrubs in a Costa Rican lowland rain forest. These ants harvest seeds from frugivore feces and cache them in their nests in partially decomposed twigs. Most harvested seeds are eaten but some are placed in viable condition on refuse piles. From 24 to 38% of the colonies (depending on ant species) contain cached seeds and 25-32% have seeds on refuse piles. Experiments with captive colonies of Pheidole nebulosa and P. nigricula demonstrated that :::::6% ofharvested Miconia nervosa and M. centrodesma seeds are deposited on refuse piles. Because seeds generally retain viability longer than the nest twig remains intact, harvested seeds are not trapped inside twigs. Experimental plantings of 4-d-old Miconia nervosa seedlings on two types of substrate (ant refuse pile vs. topsoil) under two light levels (equivalent to small and large clearings) demonstrated that seedlings grew faster and survived better on refuse piles under light levels typical of small clearings. Light levels typical of large gaps are not necessarily advantageous for establishment of understory rain forest plants.These results illustrate the dynamic nature of a tropical soil seed bank and the complexity of plant-animal interactions that occur there. Ants are simultaneously antagonistic and mutualistic towards seeds, killing most but significantly benefiting some. This interaction is extremely common (Pheidole density > 300 individuals/m 2 ) and likely influences plant recruitment patterns. Our results challenge the generalizations that small seeds are largely protected from predation because of their size, that post-dispersal seed harvesting is equivalent to seed predation, that competition among seedlings from a frugivore defecation is common, and that small seeds accumulate over long periods of time in the seed bank. We hypothesize that differential harvesting and treatment of seeds by ant species may be a mechanism underlying community-level patterns of regeneration in small-seeded plants. Also, the incidental benefits to uneaten seeds deposited on refuse piles provide additional evidence that myrmecochory evolved in plants that strengthened rare but consistent benefits of being harvested by "granivorous" ants.

Individuals who are screened for lung cancer and receive an indeterminate or suspicious screening result have some negative psychological effects from being screened. The results suggest that individuals who are considering screening should be fully informed of the risk of negative psychosocial consequences and that individuals who have been screened should receive clear and detailed information on interpreting screening results.

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Objective. To determine how reliance on Veterans Affairs (VA) for medical care among veterans enrolled in Medicare is affected by medical conditions, access, and patient characteristics. Data Sources/Study Setting. Department of Veterans Affairs. Study Design. We examined reliance on the VA for inpatient, outpatient, and overall medical care among all VA users in fiscal years 2003 and 2004 who were also enrolled in Medicare. We calculated the marginal effects of patient factors on VA reliance using fractional logistic regression; we also analyzed overall VA reliance separately for under-65 and age-651 groups. The primary focus of this analysis was the relationship between aggregated condition categories (ACCs), which represent medical conditions, and reliance on the VA. Principal Findings. Mean VA reliance was significantly higher in the under-65 population than in the age-651 group (0.800 versus 0.531). Lower differential distance to the VA, and higher VA-determined priority for health care, predicted higher VA reliance. Most individual ACCs were negatively associated with VA reliance, though substance abuse and mental health disorders were significantly associated with increased reliance on VA care. Conditions of the eyes and ears/nose/throat had positive marginal effect on VA reliance for the under 65, while diabetes was positive for age 651. Among inpatients, veterans with ACCs for mental health conditions, eye conditions, amputations, or infectious and parasitic conditions had higher likelihood of a VA hospitalization than inpatients without these conditions. Conclusions. Many dually enrolled Veterans use both Medicare and VA health care. Age, accessibility, and priority level for VA services have a clear relationship with VA reliance. Because dual use is common, coordination of care among health care settings for such patients should be a policy priority.