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Recent studies conducted in patients with chronic diseases have reported an inverse association between body mass index (BMI) and mortality. However, the question as to whether BMI may predict prognosis in patients with metastatic cancer remains open. We therefore designed the current retrospective study to investigate the potential association between BMI and overall survival (OS) in patients with distant metastases (DM) and a favorable performance status. Between 2000 and 2012, a total of 4010 cancer patients with DM who required radiotherapy (RT) and had their BMI measured at the initiation of RT were identified. The relation between BMI and OS was examined by univariate and multivariable analysis. The median OS time was 3.23 months (range: 0.1–122.17) for underweight patients, 6.08 months (range: 0.03–149.46) for normal‐weight patients, 7.99 months (range: 0.07–158.01) for overweight patients, and 12.49 months (range, 0.2–164.1) for obese patients (log‐rank: P < 0.001). Compared with normal‐weight patients, both obese (HR = 0.676; 95% P < 0.001) and overweight individuals (HR = 0.84; P < 0.001) had a reduced risk of all‐cause mortality in multivariable analysis. Conversely, underweight patients had a significantly higher risk of death from all causes (HR = 1.41; P < 0.001). Overweight and obesity are independent predictors of better OS in metastatic patients with a good performance status. Increased BMI may play a role to identify metastatic patients with superior survival outcome and exhibit a potential to encourage aggressive management in those patients even with metastases.

Scholars from many different intellectual disciplines have attempted to measure, estimate, or quantify resilience. However, there is growing concern that lack of clarity on the operationalization of the concept will limit its application. In this paper, we discuss the theory, research development and quantitative approaches in ecological and community resilience. Upon noting the lack of methods that quantify the complexities of the linked human and natural aspects of community resilience, we identify several promising approaches within the ecological resilience tradition that may be useful in filling these gaps. Further, we discuss the challenges for consolidating these approaches into a more integrated perspective for managing social-ecological systems.

BackgroundVulnerability mapping based on vulnerability indices is a pragmatic approach for highlighting the areas in a city where people are at the greatest risk of harm from heat, but the manner in which vulnerability is conceptualized influences the results.ObjectivesWe tested a generic national heat-vulnerability index, based on a 10-variable indicator framework, using data on heat-related hospitalizations in Phoenix, Arizona. We also identified potential local risk factors not included in the generic indicators.MethodsTo evaluate the accuracy of the generic index in a city-specific context, we used factor scores, derived from a factor analysis using census tract–level characteristics, as independent variables, and heat hospitalizations (with census tracts categorized as zero-, moderate-, or high-incidence) as dependent variables in a multinomial logistic regression model. We also compared the geographical differences between a vulnerability map derived from the generic index and one derived from actual heat-related hospitalizations at the census-tract scale.ResultsWe found that the national-indicator framework correctly classified just over half (54%) of census tracts in Phoenix. Compared with all census tracts, high-vulnerability tracts that were misclassified by the index as zero-vulnerability tracts had higher average income and higher proportions of residents with a duration of residency < 5 years.ConclusionThe generic indicators of vulnerability are useful, but they are sensitive to scale, measurement, and context. Decision makers need to consider the characteristics of their cities to determine how closely vulnerability maps based on generic indicators reflect actual risk of harm.CitationChuang WC, Gober P. 2015. Predicting hospitalization for heat-related illness at the census-tract level: accuracy of a generic heat vulnerability index in Phoenix, Arizona (USA). Environ Health Perspect 123:606–612; http://dx.doi.org/10.1289/ehp.1307868

We aimed to determine whether body composition assessment before treatment can predict outcomes in patients with head and neck cancer (HNC). All 881 patients with locoregional head and neck cancer treated with curative intent radiotherapy (RT) between 2005 and 2012 were retrospectively investigated. Body composition was analyzed via pre‐RT planning computed tomography (CT) images. Subcutaneous adipose tissue (SAT) and skeletal muscle (SM) indices were measured cross‐sectionally at the level of the third thoracic vertebra. Overall survival (OS), locoregional control (LRC), and distant metastasis‐free survival (MFS) were analyzed by body composition index and body mass index (BMI). Survivors were followed up for a median of 4.68 years. The SAT indices in female patients were significantly higher than those in males (P < 0.001). The median SAT and muscle indices were 18.6 and 34.3 cm2/m2 for women and 6.19 and 51.74 cm2/m2 for men, respectively. The 5‐ and 10‐year MFS, LRC, and OS rates were 83% and 82.1%, 73.4% and 71.4%, and 66.4 and 57.6%, respectively. Higher pretreatment SAT index was associated with MFS (hazard ratio [HR]: 0.65; P = 0.015), LRC (HR: 0.758; P = 0.047), and OS (HR: 0.604; P < 0.001). Higher pretreatment BMI was associated with MFS (HR: 0.642; P = 0.031) and OS (HR: 0.615; P < 0.001). The pretreatment SM index had no significant effect on MFS, LRC, and OS. Multivariate analysis revealed that T‐stage, N‐stage, lesion sites, age, and RT treatment days are independent factors associated with OS; T‐stage, N‐stage, and lesion sites are independent factors associated with MFS; and N‐stage, smoking history, and betel quid chewing history are independent factors associated with LRC. A higher CT‐assessed SAT index predicts superior MSF, LCR, and OS in patients with curative HNC, whereas SM does not predict survival or locoregional control.

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Many cities are experiencing long-term declines in population and economic activity. As a result, frameworks for urban sustainability need to address the unique challenges and opportunities of such shrinking cities. Shrinking, particularly in the U.S., has led to extensive vacant land. The abundance of vacant land reflects a loss of traditional urban amenities, economic opportunity, neighbors, businesses, and even basic city services and often occurs in neighborhoods with socially and economically vulnerable or underserved populations. However, vacant land also provides opportunities, including the space to invest in green infrastructure that can provide ecosystem services and support urban sustainability. Achieving desirable amenities that provide ecosystem services from vacant land is the central tenet of a recent urban sustainability framework termed ecology for the shrinking city. An agroecological approach could operationalize ecology for the shrinking city to both manage vacancy and address ecosystem service goals. Developing an agroecology in shrinking cities not only secures provisioning services that use an active and participatory approach of vacant land management but also transforms and enhances regulating and supporting services. The human and cultural dimensions of agroecology create the potential for social-ecological innovations that can support sustainable transformations in shrinking cities. Overall, the strength of agroecological principles guiding a green infrastructure strategy stems from its explicit focus on how individuals and communities can shape their environment at multiple scales to produce outcomes that reflect their social and cultural context. Specifically, the shaping of the environment provides a pathway for communities to build agency and manage for resilience in urban social-ecological systems. Agroecology for the shrinking city can support desirable transformations, but to be meaningful, we recognize that it must be part of a greater strategy that addresses larger systemic issues facing shrinking cities and their residents.

Natural disasters, such as hurricanes and forest fires, could trigger collapse and reorganization of social-ecological systems. In the face of external perturbations, a resilient system would have capacity to absorb impacts, adapt to change, learn, and if needed, reorganize within the same regime. Within this context, we asked how human and natural systems in Louisiana responded to Hurricane Katrina, and how the natural disaster altered the status of these systems. This paper discusses community resilience to natural hazards and addresses the limitations for assessing disaster resilience. Furthermore, we assessed social and environmental change in New Orleans and southern Louisiana through both a spatial and temporal lens (i.e., pre-and post-Katrina). By analyzing changes in system condition using social, economic and environmental factors, we identified some of the characteristics of the system's reorganization trajectories. Our results suggest that although the ongoing population recovery may be a sign of revitalization, the city and metropolitan area continue to face socioeconomic inequalities and environmental vulnerability to natural disasters. Further, the spatial distribution of social-ecological condition over time reveals certain levels of change and reorganization after Katrina, but the reorganization did not translate into greater equity. This effort presents an enhanced approach to assessing social-ecological change pre and post disturbance and provides a way forward for characterizing pertinent aspects of disaster resilience.