DETERMINING THE RACIAL AND ETHNIC DIFFERENCES IN NEONATAL INTENSIVE CARE UNIT ADMISSION RATES

Background: Recent trends show that the utilization of neonatal intensive care unit (NICU) has extended beyond severely ill infants and increased substantially across all birth weights. However, little is known about what drives the growth of NICU admission rates and whether these trends differ by race/ethnicity. Methods: The study used 2008-2018 Natality Files with restricted use of state and county-level information. Crude and risk-adjusted NICU admission rates, overall and stratified by birth weight group, were compared between black and white infants and between Hispanic and white infants. Kitagawa decomposition and Oaxaca-Blinder decomposition analyses were conducted for the temporal increase in NICU admission rates by race/ethnicity. Results: Overall NICU admission rates increased by 37% from 2008 to 2018, and the increasing trends were observed among all racial and ethnic groups. The absolute and percent increases were the smallest among white infants. NICU admission rates remained highest among black infants. Hispanic infants had the lowest NICU admission rates in early study years but reached rates similar to those of white infants in later years. Most differences in overall NICU admission rates by race/ethnicity disappeared after the risk adjustment but birth weight stratified analyses showed different patterns. Racial/ethnic differences diminished in the very low birth weight and moderately low birth weight groups while risk-adjusted NICU admission rates remained higher among black and Hispanic infants in the normal to high birth weight group. Kitagawa decomposition found that the overall increase in NICU admission rates was decomposed into 3.4% attributed to changes in the birth weight distribution and 96.6% attributed to changes in the birth weightspecific NICU admission rate. Oaxaca-Blinder decomposition analysis showed that changes in infant health risk contributed 0.87 and 0.47 of NICU admission rate increase per 100 infants among black and Hispanic infants respectively, while it mitigated the increase by 0.14 among white infants. Increased NICU bed supply contributed 0.48, 0.04, and 0.28 per 100 infants among white, black, and Hispanic infants, respectively. Maternal socioeconomic characteristics did not change but changes in their association with NICU admission contributed most to the NICU admission increase among all race/ethnic groups. Conclusions: Racial/ethnic differences in risk-adjusted NICU admission rates diminished among high-risk infants while black and Hispanic infants maintained higher risk-adjusted NICU admission rates among low-risk infants. The contributions of the factors affecting NICU admission growth substantially differed by race/ethnicit

The use of L1 as a writing strategy in L2 writing tasks

Numerous studies have investigated how students integrate L1 for the function of acquiring L2 writing proficiency. However, there is still no consensus that relates the degree of L1 use and various writing strategies in L2 writing to student proficiency levels and writing genres or writing tasks. The present study explored these issues over the course of 14 weeks with nine Korean university students of three different proficiency levels performing six writing tasks in two genres. The data were collected from the students‟ think-aloud protocols and retrospective interviews. The think-aloud and interview data were analyzed to examine the students‟ use of L1 during the L2 writing. The think-aloud protocols were also coded into their functions for what purposes each language type was used. The results showed that lower level students used their L1 more than the advanced students, but all students used L1 to different degrees depending on each task. In other words, the students reacted differently in accordance with task familiarity and the relative ease or difficulty of the task. The study also found that there was no consistent relationship between language proficiency and the types of writing strategies the students used in L2 composition. On the other hand, this study showed that although the types of writing strategies the students employed were similar, the students of various proficiency levels applied L1 strategies to their writing in different ways. The findings showed that L1 use in L2 writing can play an encouraging role for both the ideational and compensatory purposes, suggesting that the strategic use of L1 can contribute to improvement in L2 composition. The paper discusses that writing instruction should focus more on the topics of how to use writing strategies as well as what writing strategies to use

Re-Evaluating the Gender Gap: a Cross-Sectional analysis of accepted american academy of Neurology annual Meeting abstracts in 2020 and 2021

BACKGROUND AND OBJECTIVE: Prior studies reveal that invited speaker panels, editorial boards, authors of practice guidelines, and senior authors of published articles are disproportionately male in the neurology field. We aimed to analyze a gender gap in authorship of accepted abstracts to the American Academy of Neurology annual meetings in 2020 and 2021. DESIGN/METHODS: This is a cross-sectional study evaluating the proportions of female first and senior abstract authors in 2020 and 2021. Abstracts were reviewed manually ( RESULTS: Accepted abstracts with female first and senior authors comprised 46%, 34% in 2020, and the same in 2021, without change. Female senior authors had a significantly higher proportion of female first authors than their male senior author counterparts. The analysis of subspecialties with more than 100 abstracts showed the lowest percentages of female senior authors was oncology (24.7%), sleep (25.5%), headache (28.7%), and cerebrovascular disease (29%) in 2020. Cerebrovascular disease (29%) and behavioral neurology (24.7%) had the lowest percentage of female senior authors in 2021. In the analysis of the origin of research, corporate-affiliated authors had the lowest percentages of female first (34 and 36%) and senior authors (22.6 and 27.6%). CONCLUSION: The gender gap in neurology was reaffirmed in regards to female senior authorship overall and in subgroups of abstracts including cerebrovascular disease, headache, behavioral neurology, sleep, oncology, and corporate-affiliated research

Trends and Seasonality of Emergency Department Visits and Hospitalizations For Suicidality among Children and adolescents in the Us From 2016 to 2021

IMPORTANCE: The detection of seasonal patterns in suicidality should be of interest to clinicians and US public health officials, as intervention efforts can benefit by targeting periods of heightened risk. OBJECTIVES: to examine recent trends in suicidality rates, quantify the seasonality in suicidality, and demonstrate the disrupted seasonality patterns during the spring 2020 COVID-19-related school closures among US children and adolescents. DESIGN, SETTING, AND PARTICIPANTS: This population-based, descriptive cross-sectional study used administrative claims data from Optum\u27s deidentifed Clinformatics Data Mart Database. Participants included children aged 10 to 12 years and adolescents aged 13 to 18 years who were commercially insured from January 1, 2016, to December 31, 2021. Statistical analysis was conducted between April and November 2022. EXPOSURES: Month of the year and COVID-19 pandemic. MAIN OUTCOMES AND MEASURES: Rates and seasonal patterns of emergency department (ED) visits and hospitalizations for suicidality. RESULTS: The analysis included 73 123 ED visits and hospitalizations for suicidality reported between 2016 and 2021. Among these events, 66.1% were reported for females, and the mean (SD) age at the time of the event was 15.4 (2.0) years. The mean annual incidence of ED visits and hospitalizations for suicidality was 964 per 100 000 children and adolescents (95% CI, 956-972 per 100 000), which increased from 760 per 100 000 (95% CI, 745-775 per 100 000) in 2016 to 1006 per 100 000 (95% CI, 988-10 024 per 100 000) in 2019, with a temporary decrease to 942 per 100 000 (95% CI, 924-960 per 100 000) in 2020 and a subsequent increase to 1160 per 100 000 (95% CI, 1140-1181 per 100 000) in 2021. Compared with January, seasonal patterns showed peaks in April (incidence rate ratio [IRR], 1.15 [95% CI, 1.11-1.19]) and October (IRR, 1.24 [95% CI, 1.19-1.29]) and a nadir in July (IRR, 0.63 [95% CI, 0.61-0.66]) during pre-COVID-19 years and 2021. However, during the spring of 2020, which coincided with school closures, seasonal patterns were disrupted and April and May exhibited the lowest rates. CONCLUSIONS AND RELEVANCE: The findings of this study indicated the presence of seasonal patterns and an observed unexpected decrease in suicidality among children and adolescents after COVID-19-related school closures in March 2020, which suggest a potential association between suicidality and the school calendar

Crystal structure of a Fanconi anemia-associated nuclease homolog bound to 5′ flap DNA: basis of interstrand cross-link repair by FAN1

Fanconi anemia (FA) is an autosomal recessive genetic disorder caused by defects in any of 15 FA genes responsible for processing DNA interstrand cross-links (ICLs). The ultimate outcome of the FA pathway is resolution of cross-links, which requires structure-selective nucleases. FA-associated nuclease 1 (FAN1) is believed to be recruited to lesions by a monoubiquitinated FANCI–FANCD2 (ID) complex and participates in ICL repair. Here, we determined the crystal structure of Pseudomonas aeruginosa FAN1 (PaFAN1) lacking the UBZ (ubiquitin-binding zinc) domain in complex with 5′ flap DNA. All four domains of the right-hand-shaped PaFAN1 are involved in DNA recognition, with each domain playing a specific role in bending DNA at the nick. The six-helix bundle that binds the junction connects to the catalytic viral replication and repair (VRR) nuclease (VRR nuc) domain, enabling FAN1 to incise the scissile phosphate a few bases distant from the junction. The six-helix bundle also inhibits the cleavage of intact Holliday junctions. PaFAN1 shares several conserved features with other flap structure-selective nucleases despite structural differences. A clamping motion of the domains around the wedge helix, which acts as a pivot, facilitates nucleolytic cleavage. The PaFAN1 structure provides insights into how archaeal Holliday junction resolvases evolved to incise 5′ flap substrates and how FAN1 integrates with the FA complex to participate in ICL repair

Contemporary analysis of Reexcision and Conversion to Mastectomy Rates and associated Healthcare Costs For Women Undergoing Breast-Conserving Surgery

PURPOSE: This study was designed to provide a comprehensive and up-to-date understanding of population-level reoperation rates and incremental healthcare costs associated with reoperation for patients who underwent breast-conserving surgery (BCS). METHODS: This is a retrospective cohort study using Merative™ MarketScan RESULTS: The commercial cohort included 17,129 women with a median age of 55 (interquartile range [IQR] 49-59) years, and the Medicare cohort included 6977 women with a median age of 73 (IQR 69-78) years. Overall reoperation rates were 21.1% (95% confidence interval [CI] 20.5-21.8%) for the commercial cohort and 14.9% (95% CI 14.1-15.7%) for the Medicare cohort. In both cohorts, reoperation rates decreased as age increased, and conversion to mastectomy was more prevalent among younger women in the commercial cohort. The mean healthcare costs during 1 year of follow-up from the initial BCS were $95,165 for the commercial cohort and$36,313 for the Medicare cohort. Reoperations were associated with 24% higher costs in both the commercial and Medicare cohorts, which translated into $21,607 and$8559 incremental costs, respectively. CONCLUSIONS: The rates of reoperation after BCS have remained high and have contributed to increased healthcare costs. Continuing efforts to reduce reoperation need more attention

Novel involvement of leukotriene B4 receptor 2 through ERK activation by PP2A down-regulation in leukotriene B4-induced keratin phosphorylation and reorganization of pancreatic cancer cells

AbstractPerinuclear reorganization via phosphorylation of specific serine residues in keratin is involved in the deformability of metastatic cancer cells. The level of leukotriene B4 is high in pancreatic cancers. However, the roles of LTB4 and its cognate receptors in keratin reorganization of pancreatic cancers are not known. LTB4 dose-dependently induced phosphorylation and reorganization of Keratin 8 (K8) and these processes were reversed by LY255283 (BLT2 antagonist). BLT2 agonists such as Comp A and 15(S)-HETE also induced phosphorylation of serine 431 in K8. Moreover, Comp A-induced K8 phosphorylation and reorganization were blocked by LY255283. Gene silencing of BLT2 suppressed Comp A-induced K8 phosphorylation and reorganization in PANC-1 cells. Over-expression of BLT2 promoted K8 phosphorylation. Comp A promoted the migration of PANC-1 cells in a dose-dependent manner, and LY255283 blocked Comp A-induced migration, respectively. PD98059 (ERK inhibitor) suppressed Comp A-induced phosphorylation of serine 431 and reorganization of K8. Gene silencing of BLT2 suppressed the expression of pERK, and over-expression of BLT2 increased the expression of pERK even without Comp A. Comp A induced the expression of active ERK (pERK) and BLT2. These inductions were blocked by PD98059. Comp A decreased PP2A expression and hindered the binding of PP2A to the K8, leading to the activation of ERK. PD98059 suppressed the Comp A-induced migration of PANC-1 cells and BLT2 over-expression-induced migration of PANC-1 cells. Overall, these results suggest that BLT2 is involved in LTB4‐induced phosphorylation and reorganization through ERK activation by PP2A downregulation, leading to increased migration of PANC‐1 cells

Underutilization of Endovascular Therapy in Black Patients With Ischemic Stroke: An Analysis of State and Nationwide Cohorts

BACKGROUND AND PURPOSE: Endovascular therapy (EVT) is a very effective treatment but relies on specialized capabilities that are not available in every hospital where acute ischemic stroke is treated. Here, we assess whether access to and utilization of this therapy has extended uniformly across racial and ethnic groups. METHODS: We conducted a retrospective, population-based study using the 2019 Texas Inpatient Public Use Data File. Acute ischemic stroke cases and EVT use were identified using the RESULTS: Among 40 814 acute ischemic stroke cases in Texas in 2019, 54% were White, 17% Black, and 21% Hispanic. Black patients had similar admissions to EVT-performing hospitals and greater admissions to comprehensive stroke centers (CSCs) compared with White patients (EVT 62% versus 62%, CONCLUSIONS: We found no evidence of disparity in presentation to EVT-performing hospitals or CSCs; however, lower rates of EVT were observed in Black patients

Middle Meningeal artery Embolization For Chronic Subdural Hematomas With Concurrent antithrombotics

BACKGROUND: Chronic subdural hematoma (CSDH) is an increasingly prevalent disease in the aging population. Patients with CSDH frequently suffer from concurrent vascular disease or develop secondary thrombotic complications requiring antithrombotic treatment. OBJECTIVE: to determine the safety and impact of early reinitiation of antithrombotics after middle meningeal artery embolization for chronic subdural hematoma. METHODS: This is a single-institution, retrospective study of patients who underwent middle meningeal artery (MMA) embolizations for CSDH. Patient with or without antithrombotic initiation within 5 days postembolization were compared. Primary outcome was the rate of recurrence within 60 days. Secondary outcomes included rate of reoperation, reduction in CSDH thickness, and midline shift. RESULTS: Fifty-seven patients met inclusion criteria. The median age was 66 years (IQR 58-76) with 21.1% females. Sixty-six embolizations were performed. The median length to follow-up was 20 days (IQR 14-44). Nineteen patients (33.3%) had rapid reinitiation of antithrombotics (5 antiplatelet, 11 anticoagulation, and 3 both). Baseline characteristics between the no antithrombotic (no-AT) and the AT groups were similar. The recurrence rate was higher in the AT group (no-AT vs AT, 9.3 vs 30.4%, P = .03). Mean absolute reduction in CSDH thickness and midline shift was similar between groups. Rate of reoperation did not differ (4.7 vs 8.7%, P = .61). CONCLUSION: Rapid reinitiation of AT after MMA embolization for CSDH leads to higher rates of recurrence with similar rates of reoperation. Care must be taken when initiating antithrombotics after treatment of CSDH with MMA embolization

Middle Meningeal artery Embolization of Septated Chronic Subdural Hematomas

INTRODUCTION: Middle meningeal artery embolization (MMAE) has emerged as a promising new treatment for patients with chronic subdural hematomas (cSDH). Its efficacy, however, upon the subtype with a high rate of recurrence-septated cSDH-remains undetermined. METHODS: From our prospective registry of patients with cSDH treated with MMAE, we classified patients based on the presence or absence of septations. The primary outcome was the rate of recurrence of cSDH. Secondary outcomes included a reduction in cSDH thickness, midline shift, and rate of reoperation. RESULTS: Among 80 patients with 99 cSDHs, the median age was 68 years (IQR 59-77) with 20% females. Twenty-eight cSDHs (35%) had septations identified on imaging. Surgical evacuation with burr holes was performed in 45% and craniotomy in 18.8%. Baseline characteristics between no-septations (no-SEP) and septations (SEP) groups were similar except for median age (SEP vs no-SEP, 72.5 vs. 65.5, p CONCLUSION: MMAE appears to be equal to potentially more effective in preventing the recurrence of cSDH in septated lesions. These findings may aid in patient selection