Racial and ethnic disparities in short interval pregnancy following delivery in Catholic vs non-Catholic hospitals among California Medicaid enrollees.

OBJECTIVES: We examined the impact of Catholic hospital delivery on short interval pregnancy in the California 2010-2014 Medicaid population. STUDY DESIGN: We used Cox regression to estimate the association between hospital affiliation and short interval pregnancy, adjusting for patient factors. RESULTS: Catholic hospital delivery had increased the risk of pregnancy within 6 months for Black (hazard ratio [HR] 1.11, 95% CI 1.06, 1.17) and Hispanic (HR 1.07, 95% CI 1.05, 1.09) but not for White women (HR 1.02, 95% CI 0.98, 1.05). CONCLUSIONS: Among California women with Medicaid, Catholic hospital delivery was associated with short interval pregnancy only among women of color.

The association between neighborhood disadvantage and frailty: A retrospective case series.

Background: Frailty predicts poorer outcomes in surgical patients. Recent studies have found socioeconomic status to be an important characteristic for surgical outcomes. We evaluated the association of Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), two geospatial atlases that provide a multidimensional evaluation of neighborhood deprivation, with frailty in a surgery population. Design & methods: A retrospective study of patients undergoing routine frailty screening was conducted 12/2020-8/2022. Frailty was measured using Fried's Frailty Phenotype (FFP) and the five-item Modified Frailty Index (mFI-5). ADI and SVI quartiles were determined using patient residence. Logistic regression models were used to evaluated associations of FFP (frail only vs not frail) and mFI-5 (≥2 vs 0-1) with ADI and SVI (α = 0.05). Results: Of 372 screened patients, 41% (154) were women, median age was 68% (63-74), and 46% (170) identified as non-White. Across ADI and SVI quartiles, higher number of comorbidities, decreasing median income, and frailty were associated with increasing deprivation (p < 0.01). When controlling for age, sex, comorbidities, and BMI category, frailty by FFP was associated with the most deprived two quartiles of ADI (OR 2.61, CI: [1.35-5.03], p < 0.01) and the most deprived quartile of SVI (OR 2.33, [1.10-4.95], p < 0.05). These trends were also seen with mFI-5 scores ≥2 (ADI: OR 1.64, [1.02-2.63], p < 0.05; SVI: OR 1.71, [1.01-2.91], p < 0.05). Conclusions: Surgical patients living in socioeconomically deprived neighborhoods are more likely to be frail. Interventions may include screening of disadvantaged populations and resource allocation to vulnerable neighborhoods.

Comparative outcomes of partial versus total penectomy for penile carcinoma: A retrospective cohort study on demographics and postoperative complications.

When feasible from an oncologic standpoint, partial penectomy (PP) is often preferred to total penectomy (TP) for penile cancer treatment, for the preservation of functional urinary outcomes. However, to date, there has not been a direct comparison of perioperative outcomes between PP and TP. Comparing treatments for penile cancer has proven difficult due to the rarity of penile cancer in the United States. We aimed to report differences in pre-operative risk factors, intra-operative outcomes, and postoperative outcomes between TP and PP for penile cancer. Using the National Surgical Quality Improvement Program database, we conducted a retrospective cohort review of penile cancer patients enlisted in the database between the years 2006-2016 using the International Classification of Diseases clinical modification 9th revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. PP patients were less likely to be transferred patients (p = 0.002), diabetic (p = 0.026), and were more likely to have preoperative laboratory values within normal limits. PP patients also had shorter lengths of stay in the hospital (p < 0.001) and operating time (p < 0.001). Significant differences were also found for inpatient stay (p < 0.001), 30-day post-surgery complications (p < 0.001), deep incisional surgical site infection (SSI) (p = 0.017), wound disruption (p = 0.017), intraoperative or postoperative transfusion (p = 0.029), and sepsis (p < 0.005). Finally, PP patients required fewer concurrent surgical procedures (p < 0.001). Demographic differences between PP and TP patients may reflect patients presenting with more advanced oncologic disease. PP is associated with fewer postoperative complications, shorter surgeries, shorter hospital stays, fewer concurrent surgical procedures, and comorbid conditions compared to TP. A gap remains in the reported data pertaining to postoperative sexual function and erectile outcomes for PP at a national level.

A pilot study on metabolomic characterization of human glioblastomas and patient plasma.

Purpose: To determine whether recurrent GBMs are metabolically distinct from primary GBM, and whether patient plasma can be used as a liquid biopsy to reflect this difference. Methods: In a single center cohort study, tissue and blood samples from 15 patients with glioblastoma (9 glioblastoma tissues at diagnosis, 3 pairs of tissue, and 6 pairs of plasma specimens at diagnosis and at recurrence) were analyzed. Results: Several metabolites had significant alternations in both tumor and plasma specimens. In the tissue, the following representative metabolites had a significant increase in peak intensity at recurrence compared to diagnosis: N-alpha-methylhistamine (p = 0.037), glycerol-3-phosphate (p = 0.029), phosphocholine (p = 0.045), and succinic acid (p = 0.025). In patient plasma, metabolites that significantly increased at recurrence included: 2,4-difluorotoluene (p = 0.031), diatrizoic acid (p = 0.032), indole-3-acetate with (p = 0.029), urea (P = 0.025), pseudouridine (p = 0.042), and maltose (p = 0.035). Metabolites that significantly decreased in plasma at recurrence were: eicosenoic acid (p = 0.017), glucose-1-phosphate (p = 0.017), FA 18:2 (linoleic acid) (p = 0.017), arginine (p = 0.036), fatty acids 20:3 (homo-gamma-linolenic acid (p = 0.036), galactosamine (p = 0.007), and FA 18:3 (linolenic acid) (P = 0.012). Principal component analysis showed that the metabolomic profiles differ between tumor tissue and patient plasma. Conclusions: Our data suggest that metabolomic profiles of human GBM tissue and patient plasma differ at diagnosis and at recurrence. Many metabolites involved in tumorigenesis and metabolomic flexibility were identified. A larger study using targeted metabolomic assay is warranted to measure the levels of these metabolites, which will help identify the metabolomic signatures in both GBM tissue and patient plasma for risk stratification, clinical outcome prediction, and development of new adjuvant metabolomic-targeting therapy.

The Role of Internal Medicine-Pediatric Programs and Transition Champions in Graduate Medical Trainee Health Care Transition Development.

OBJECTIVE: Transition to adult health care for adolescents and young adults (AYAs), especially those with chronic conditions, is a critical time. Medical trainees lack competency in providing transition care, but little is known about the factors contributing to the development of health care transition (HCT) knowledge, attitudes, and practice. This study examines how Internal Medicine-Pediatrics (Med-Peds) programs and institutional HCT champions influence trainee HCT knowledge, attitudes, and practices. STUDY DESIGN: A 78-item electronic survey regarding the knowledge, attitudes, and practices of caring for AYA patients was sent to trainees from 11 graduate medical institutions. RESULTS: A total of 149 responses were analyzed, including 83 from institutions with Med-Peds programs and 63 from institutions without Med-Peds programs. Trainees with an institutional Med-Peds Program were more likely to identify an institutional HCT champion (odds ratio, 10.67; 95% confidence interval, 2.40-47.44; p = .002). The mean HCT knowledge scores and use of a routine, standardized HCT tools were higher in trainees with an institutional HCT champion. Trainees without an institutional Med-Peds program experienced more barriers to HCT education. Trainees with institutional HCT champions or Med-Peds programs reported greater comfort in providing transition education and using validated, standardized transition tools. DISCUSSION: The presence of a Med-Peds residency program was associated with a greater likelihood of a visible institutional HCT champion. Both factors were associated with increased HCT knowledge, positive attitudes, and HCT practices. Both clinical champions and adoption of Med-Peds program curricula will enhance HCT training within graduate medical education.

The Impacts of Three Educational Technologies on Algebraic Understanding in the Context of COVID-19.

The current study investigated the effectiveness of three distinct educational technologies-two game-based applications (From Here to There and DragonBox 12+) and two modes of online problem sets in ASSISTments (an Immediate Feedback condition and an Active Control condition with no immediate feedback) on Grade 7 students' algebraic knowledge. More than 3,600 Grade 7 students across nine in-person and one virtual schools within the same district were randomly assigned to one of the four conditions. Students received nine 30-minute intervention sessions from September 2020 to March 2021. Hierarchical linear modeling analyses of the final analytic sample (N = 1,850) showed significantly higher posttest scores for students who used From Here to There and DragonBox 12+ compared to the Active Control condition. No significant difference was found for the Immediate Feedback condition. The findings have implications for understanding how game-based applications can affect algebraic understanding, even within pandemic pressures on learning.

Effects of bilingual language experience on basal ganglia computations: A dynamic causal modeling test of the conditional routing model.

Bilingual language control is characterized by the ability to select from amongst competing representations based on the current language in use. According to the Conditional Routing Model (CRM), this feat is underpinned by basal-ganglia signal-routing mechanisms, and may have implications for cognitive flexibility. The current experiment used dynamic causal modeling of fMRI data to compare network-level brain functioning in monolinguals and bilinguals during a task that required productive (semantic decision) and receptive (language) switches. Consistent with the CRM, results showed that: (1) both switch types drove activation in the basal ganglia, (2) bilinguals and monolinguals differed in the strength of influence of dorsolateral prefrontal cortex (DLPFC) on basal ganglia, and (3) differences in bilingual language experience were marginally related to the strength of influence of the switching drives onto basal ganglia. Additionally, a task-by-group interaction was found, suggesting that when bilinguals engaged in language-switching, their task-switching costs were reduced.

Generation of extreme-ultraviolet beams with time-varying orbital angular momentum.

Light fields carrying orbital angular momentum (OAM) provide powerful capabilities for applications in optical communications, microscopy, quantum optics, and microparticle manipulation. We introduce a property of light beams, manifested as a temporal OAM variation along a pulse: the self-torque of light. Although self-torque is found in diverse physical systems (i.e., electrodynamics and general relativity), it was not realized that light could possess such a property. We demonstrate that extreme-ultraviolet self-torqued beams arise in high-harmonic generation driven by time-delayed pulses with different OAM. We monitor the self-torque of extreme-ultraviolet beams through their azimuthal frequency chirp. This class of dynamic-OAM beams provides the ability for controlling magnetic, topological, and quantum excitations and for manipulating molecules and nanostructures on their natural time and length scales.

Applying math onto mechanisms: mechanistic knowledge is associated with the use of formal mathematical strategies.

It is notoriously difficult for people to adaptively apply formal mathematical strategies learned in school to real-world contexts, even when they possess the required mathematical skills. The current study explores whether a problem context's mechanism can act as an "embodied analogy" onto which abstract mathematical concepts can be applied, leading to more frequent use of formal mathematical strategies. Participants were asked to program a robot to navigate a maze and to create a navigation strategy that would work for differently sized robots. We compared the strategy complexity of participants with high levels of mechanistic knowledge about the robot against participants with low levels of mechanistic knowledge about the robot. Mechanistic knowledge was significantly associated with the frequency and complexity of the mathematical strategies used by participants, suggesting that learning to recognize a problem context's mechanism may promote independent mathematical problem solving in applied contexts.

Analysis of lidocaine on the COBAS INTEGRA.

A new fluorescence polarization (FP) immunoassay was developed for the COBAS INTEGRA to quantitate lidocaine in serum and sodium heparin derived plasma. The COBAS INTEGRA, a random and continuous access clinical analyzer, performs the new lidocaine assay at a throughput of 300 tests per hour. Comparison studies with the Abbott TDx Lidocaine assay yielded a correlation coefficient of 0.99 and a regression value of INTEGRA = -0.01 + 0.95 TDx, n = 69. The assay was found to be linear throughout the concentration range of 0 to 10 micrograms/ml using CASCO STANDARDS's DOCUMENT TDM 1 Linearity Test Set and the COBAS-FP TDM Calibration Verification Test Set. The new lidocaine assay exhibited good precision as determined by the National Committee for Clinical Laboratory Standards (NCCLS) protocol EP5-T2 with total percent coefficient of variation (%CV) values of less than 4 percent across the assay range. Interference was less than 10 percent for abnormal levels of total protein (2.1 to 10 g/dl), lipid (up to 2200 mg/dl triglyceride), hemoglobin (up to 10 g/dl), and icteric samples (up to 17.5 mg/dl bilirubin). Finally, the standard curve was stable for greater than 25 weeks which was attributable to the on-board reagent cooling and a unique cassette closure system.