Black and White Patients with Inflammatory Bowel Disease Show Similar Biologic Use Patterns with Medicaid Insurance

Background: Prior studies have identified racial disparities in the treatment and outcomes of inflammatory bowel disease (IBD). These disparities could be secondary to differences in biology, care delivery, or access to appropriate therapy. The primary aim of this study was to compare medication use among Medicaid-insured black and white patients with IBD, given uniform access to gastroenterologists and therapies. Methods: We analyzed Medicaid Analytic eXtract data from 4 states (California, Georgia, North Carolina, and Texas) between 2006 and 2011. We compared the use of IBD-specific therapies, including analyses of postoperative therapy among patients with Crohn disease (CD). We performed bivariate analyses and multivariable logistic regression, adjusting for potential confounders. Results: We identified 14,735 patients with IBD (4672 black [32%], 8277 with CD [58%]). In multivariable analysis, there was no significant difference in the odds of anti-tumor necrosis factor use by race for CD (adjusted odds ratio [aOR] = 1.13; 95% confidence interval [CI], 0.99-1.28] or ulcerative colitis (aOR = 1.12; 95% CI, 0.96-1.32). Black patients with CD were more likely than white patients to receive combination therapy (aOR = 1.50; 95% CI, 1.15-1.96), and black patients were more likely than white patients to receive immunomodulator monotherapy after surgery for CD (31% vs 18%; P = 0.004). Conclusions: In patients with Medicaid insurance, where access to IBD-specific therapy should be similar for all individuals, there was no significant disparity by race in the utilization of IBD-specific therapies. Disparities in IBD treatment discussed in prior literature seem to be driven by socioeconomic or other issues affecting access to care

Characteristics of fecal microbiota transplantation use in inflammatory bowel disease cohort

Background: There is a growing interest in the role of gut bacteria in a number of diseases and an emerging hypothesis that inflammatory bowel disease (IBD) is triggered by microbial dysbiosis in genetically susceptible individuals. Currently, fecal microbiota transplantation (FMT) is utilized for the treatment of Clostridium difficile colitis. Data on the efficacy of FMT for IBD are mixed, but patients are interested in its use for the treatment of IBD. We sought to describe the use of FMT (self or medical professional administered) in individuals with IBD using IBD Partners, an Internet-based cohort. Methods: Patients enrolled in the IBD Partners cohort were offered the opportunity to complete an optional survey on the use of FMT between January 2017 to September 2018 (n = 5430). A cross-sectional analysis was performed within patients who completed the survey and did not have a pouch or ostomy. Patients' demographic characteristics, disease activity and phenotype, mode of FMT delivery, and patient-reported efficacy were compared. Results: Among 3274 eligible patients, 51 (1.6%) responded that they had an FMT in the past. Of patients undergoing FMT, 22 patients had the FMT for C. difficile while 29 reported that the FMT was for another indication. Most patients receiving FMT for an indication other than C. difficile had ulcerative colitis/indeterminate colitis (25, 86.2%). Colonoscopy (68.2%) and nasogastric tube (18.2%) were the most common routes of administration for patients receiving FMT for C. difficile colitis. Self-administration (72.4%) and enemas (17.2%) were the most common routes of administration in patients receiving FMT for an alternate indication. Patients reporting FMT for an indication other than C. difficile were less likely to have a physician directing their FMT treatment (20.6%) as compared to patients receiving FMT for C. difficile (86.3%). Patient-reported efficacy was lower for FMT given for a non-C. difficile indication. Conclusions: Patients undergoing FMT for an indication other than C. difficile infection were more likely to have ulcerative colitis, self-administer FMT, and were less likely to be receiving FMT under the guidance of a medical professional. FMT was not as effective for symptoms when given for a non-C. difficile indication. Patients should be counseled on potential harms and lack of proven benefit associated with FMT for IBD indications to try to discourage self-administered FMT without proper medical oversite

An efficient direct solver for a class of mixed finite element problems

In this paper we present an efficient, accurate and parallelizable direct method for the solution of the (indefinite) linear algebraic systems that arise in the solution of fourth-order partial differential equations (PDEs) using mixed finite element approximations. The method is intended particularly for use when multiple right-hand sides occur, and when high accuracy is required in these solutions. The algorithm is described in some detail and its performance is illustrated through the numerical solution of a biharmonic eigenvalue problem where the smallest eigenpair is approximated using inverse iteration after discretization via the Ciarlet–Raviart mixed finite element method

Spin Torques in Ferromagnetic/Normal Metal Structures

Recent theories of spin-current-induced magnetization reversal are formulated in terms of a spin-mixing conductance $G^{mix}$. We evaluate $G^{mix}$ from first-principles for a number of (dis)ordered interfaces between magnetic and non-magnetic materials. In multi-terminal devices, the magnetization direction of a one side of a tunnel junction or a ferromagnetic insulator can ideally be switched with negligible charge current dissipation.Comment: 4 pages, 1 figur

Headache in people with epilepsy

Epidemiological estimates indicate that individuals with epilepsy are more likely to experience headaches, including migraine, than individuals without epilepsy. Headaches can be temporally unrelated to seizures, or can occur before, during or after an episode; seizures and migraine attacks are mostly not temporally linked. The pathophysiological links between headaches (including migraine) and epilepsy are complex and have not yet been fully elucidated. Correct diagnoses and appropriate treatment of headaches in individuals with epilepsy is essential, as headaches can contribute substantially to disease burden. Here, we review the insights that have been made into the associations between headache and epilepsy over the past 5 years, including information on the pathophysiological mechanisms and genetic variants that link the two disorders. We also discuss the current best practice for the management of headaches co-occurring with epilepsy and highlight future challenges for this area of research.Paroxysmal Cerebral Disorder

Dynamical surface structures in multi-particle-correlated surface growths

We investigate the scaling properties of the interface fluctuation width for the $Q$-mer and $Q$-particle-correlated deposition-evaporation models. These models are constrained with a global conservation law that the particle number at each height is conserved modulo $Q$. In equilibrium, the stationary roughness is anomalous but universal with roughness exponent $\alpha=1/3$, while the early time evolution shows nonuniversal behavior with growth exponent $\beta$ varying with models and $Q$. Nonequilibrium surfaces display diverse growing/stationary behavior. The $Q$-mer model shows a faceted structure, while the $Q$-particle-correlated model a macroscopically grooved structure.Comment: 16 pages, 10 figures, revte

Loewner evolution driven by a stochastic boundary point

We consider evolution in the unit disk in which the sample paths are represented by the trajectories of points evolving randomly under the generalized Loewner equation. The driving mechanism differs from the SLE evolution, but nevertheless solutions possess similar invariance properties.Comment: 23 pages, 6 figure

Spin pumping and magnetization dynamics in metallic multilayers

We study the magnetization dynamics in thin ferromagnetic films and small ferromagnetic particles in contact with paramagnetic conductors. A moving magnetization vector causes \textquotedblleft pumping\textquotedblright of spins into adjacent nonmagnetic layers. This spin transfer affects the magnetization dynamics similar to the Landau-Lifshitz-Gilbert phenomenology. The additional Gilbert damping is significant for small ferromagnets, when the nonmagnetic layers efficiently relax the injected spins, but the effect is reduced when a spin accumulation build-up in the normal metal opposes the spin pumping. The damping enhancement is governed by (and, in turn, can be used to measure) the mixing conductance or spin-torque parameter of the ferromagnet--normal-metal interface. Our theoretical findings are confirmed by agreement with recent experiments in a variety of multilayer systems.Comment: 10 pages, 6 figure

Spin battery operated by ferromagnetic resonance

Precessing ferromagnets are predicted to inject a spin current into adjacent conductors via Ohmic contacts, irrespective of a conductance mismatch with, for example, doped semiconductors. This opens the way to create a pure spin source spin battery by the ferromagnetic resonance. We estimate the spin current and spin bias for different material combinations.Comment: The estimate for the magnitude of the spin bias is improved. We find that it is feasible to get a measurable signal of the order of the microwave frequency already for moderate rf intensitie

Human annoyance, acceptability and concern as responses to vibration from the construction of light rapid transit lines in residential environments

The aim of this paper is to investigate the use of different self-reported measures for assessing the human response to environmental vibration from the construction of an urban LRT (Light Rapid Transit) system. The human response to environmental stressors such as vibration and noise is often expressed in terms of exposure–response relationships that describe annoyance as a function of the magnitude of the vibration. These relationships are often the basis of noise and vibration policy and the setting of limit values. This paper examines measures other than annoyance by expressing exposure–response relationships for vibration in terms of self-reported concern about property damage and acceptability. The exposure–response relationships for concern about property damage and for acceptability are then compared with those for annoyance. It is shown that concern about property damage occurs at vibration levels well below those where there is any risk of damage. Earlier research indicated that concern for damage is an important moderator of the annoyance induced. Acceptability, on the other hand, might be influenced by both annoyance and concern, as well as by other considerations. It is concluded that exposure–response relationships expressing acceptability as a function of vibration exposure could usefully complement existing relationships for annoyance in future policy decisions regarding environmental vibration. The results presented in this paper are derived from data collected through a socio-vibration survey (N = 321) conducted for the construction of an urban LRT in the United Kingdom