Racial and Ethnic Disparities in Neurological Care in the United States.

The burden of neurological disease is increasing globally. In the United States, this burden is disproportionally greater for Black and Latino communities who have limited access to neurological care. Health services researchers have attempted to identify racial and ethnic disparities in neurological care and possible solutions. This article reviews the most current literature on racial and ethnic disparities in commonly encountered neurological conditions, including Stroke, Alzheimer's Disease, Multiple Sclerosis, Epilepsy, Parkinson's Disease, and Migraine. Disparities exist in disease incidence, diagnosis, access to care, treatment, outcomes, and representation in epidemiologic studies and clinical trials. Many of the disparities observed in neurological care in the United States are a consequence of longstanding racist and discriminatory policies and legislation that increase risk factors for the development of neurological disease or lead to disparities in accessing quality neurological care. Therefore, additional efforts on the legislative, community health, and healthcare system levels are necessary to prevent the onset of neurological disease and achieve equity in neurological care.

Association of applicant demographic factors with medical school acceptance.

BACKGROUND: Medical school acceptance rates in the United States (US) have been lower for applicants who identify as Underrepresented-in-Medicine (UiM) compared to non-UiM applicants. The gap between UiM and no-UiM groups is narrowing in recent years. Less well-studied are associations of acceptance decisions with family income and parental education. This study's purpose is to evaluate the relationships between medical school acceptance and family income, parental education status, racial/ethnic background, Grade Point Average (GPA), Medical College Admission Test (MCAT) score, and participation in extracurricular activities. METHODS: This is a cross-sectional study of first-time US medical school applicants between 2017 and 2020. Acceptance rates for first-time applicants were calculated for first-generation (FG), low-income (LI), and UiM applicants. Associations of these attributes with MCAT scores, science GPAs, and seven categories of extracurricular activities were evaluated. Regression analyses estimated associations between acceptance to medical school with all variables with and without interaction terms (FG*URM, LI*URM, FG*LI). RESULTS: The overall acceptance rate for first-time applicants from 2017-2020 was 45.3%. The acceptance rates among FG, LI and UiM applicants were 37.9%, 39.6% and 44.2%, respectively. In univariable logistic regression analyses, acceptance was negatively associated with being FG (OR: 0.68, CI: 0.67-0.70), LI (OR: 0.70, CI: 0.69-0.72), and UiM (OR: 0.95, CI: 0.93-0.97). In multivariable regression, acceptance was most strongly associated with science GPA (OR: 7.15, CI: 6.78-7.54 for the highest quintile) and UiM (OR: 5.56, CI: 5.48-5.93) status and MCAT score (OR: 1.19, CI: 1.18-1.19), FG (OR: 1.14, CI: 1.10-1.18), and most extracurricular activities. Including interaction terms revealed a negative association between acceptance and LI (OR:0.90, CI: 0.87-0.94) and FG was no longer significant (OR:1.10, CI:0.96-1.08). CONCLUSIONS: Collectively these results suggest medical school admissions committees may be relying on holistic admission practices. While MCAT and GPA scores continue to predict acceptance, individuals from racially and ethnically UiM backgrounds have favorable odds of acceptance when controlling for MCAT and GPA. However, these positive associations were not seen for low-income and first-generation applicants. Additional preparation for college and the MCAT for these latter groups may help further diversify the medical profession.

Deep Learning-Based Object Detection for Unmanned Aerial Systems (UASs)-Based Inspections of Construction Stormwater Practices.

Construction activities typically create large amounts of ground disturbance, which can lead to increased rates of soil erosion. Construction stormwater practices are used on active jobsites to protect downstream waterbodies from offsite sediment transport. Federal and state regulations require routine pollution prevention inspections to ensure that temporary stormwater practices are in place and performing as intended. This study addresses the existing challenges and limitations in the construction stormwater inspections and presents a unique approach for performing unmanned aerial system (UAS)-based inspections. Deep learning-based object detection principles were applied to identify and locate practices installed on active construction sites. The system integrates a post-processing stage by clustering results. The developed framework consists of data preparation with aerial inspections, model training, validation of the model, and testing for accuracy. The developed model was created from 800 aerial images and was used to detect four different types of construction stormwater practices at 100% accuracy on the Mean Average Precision (MAP) with minimal false positive detections. Results indicate that object detection could be implemented on UAS-acquired imagery as a novel approach to construction stormwater inspections and provide accurate results for site plan comparisons by rapidly detecting the quantity and location of field-installed stormwater practices.

Groundwater flow in saturated riparian buffers and implications for nitrate removal.

A saturated riparian buffer (SRB) is an edge-of-field conservation practice that intercepts tile drainage and reduces nitrate flux to nearby streams by redistributing the flow as shallow groundwater. In this study, a three-dimensional, finite-difference groundwater model representative of SRBs in central Iowa was developed to assess the flow of groundwater and implications for nitrate removal during spring conditions, when flow to the SRB is highest. The model reproduces field observations of water level with Nash-Sutcliffe efficiency of 0.68, which is deemed acceptable for hydrologic models. The modeling shows that groundwater flow is three-dimensional near the distribution pipe and the stream and primarily one-dimensional in the rest of the buffer. The path the water takes in flowing toward the stream depends on where it exits the distribution pipe. When nitrate is not limiting, the potential for nitrate removal depends on the length of the path-and thus travel time-and depth because denitrification potential varies with depth. Travel time Tt can be estimated well with slight modifications to a one-dimensional approximation: Tt = 1.11Lx /vx , where Lx is the buffer width and vx is a one-dimensional approximation of the average linear velocity of groundwater. Refining knowledge of SRB function is an important step toward enhancing design for improving water quality.

Slope stability of streambanks at saturated riparian buffer sites.

Saturated riparian buffers (SRBs) reduce nitrate export from agricultural tile drainage by infusing drainage water into carbon-rich riparian soils where denitrification and plant uptake occur. The water quality benefits from SRBs are well documented, but uncertainties about their effect on streambank stability have led to design standards that limit the maximum bank height and minimum buffer width, thus reducing the number of suitable candidate sites. In this study, the relationship between SRB design and streambank stability was examined through numerical slope stability modeling and validated using field sites. At the study sites, the addition of SRB flow increased the probability of failure by less than 3% for both simulated dry and rainfall scenarios. Furthermore, the simulations provide no evidence to support excluding potential sites based on bank height alone. Multivariate analysis of dimensionless parameters developed for SRB flow conditions was used to predict the factor of safety as a function of the SRB site and design conditions. The equation presented allows designers to assess the stability of a potential site where bank failure poses a heightened risk. The results of this study alleviate the need for extensive geotechnical evaluations at future SRB sites and could increase SRB implementation by expanding the range of eligible sites.

Improving the effectiveness of saturated riparian buffers for removing nitrate from subsurface drainage.

A saturated riparian buffer (SRB) is an edge-of-field conservation practice that reduces nitrate export from agricultural lands by redistributing tile drainage as shallow groundwater and allowing for denitrification and plant uptake. We propose an approach to improve the design of SRBs by analyzing a tradeoff in choosing the SRB width, and we apply the approach to six sites with SRBs in central Iowa. A larger width allows for more residence time, which increases the opportunity for removing nitrate that enters the buffer. However, because the SRBs considered here treat only a portion of the tile flow when it is large, for the same difference in hydraulic head, a smaller width allows more of the total tile flow to enter the buffer and therefore treats more of the drainage. By maximizing the effectiveness of nitrate removal, defined as the ratio of total nitrate removed by the SRB to total nitrate leaving the field in tile drainage, an equation for the optimal width was derived in terms of soil properties, denitrification rates, and head difference. All six sites with existing SRBs considered here have optimal widths smaller than the current width, and two are below the minimum width listed in current design standards. In terms of uncertainty, the main challenges in computing the optimal width for a site are estimating the removal coefficient for nitrate and determining the saturated hydraulic conductivity. Nevertheless, including a width that accounts for site conditions in the design standards would improve water quality locally and regionally.

A case series of PD-1 inhibitor-associated paraneoplastic neurologic syndromes.

Immune checkpoint inhibitors (ICIs) are highly efficacious for treating many solid tumor types. Because of their immune-activating mechanism of action, ICIs can trigger various immune-mediated toxicities. We present three cases: i) a woman with anti-Ri brainstem encephalitis; ii) a man with anti-Hu sensory neuronopathy; and iii) a woman with suspected combined anti-Hu and anti-NMDA paraneoplastic syndromes associated with the initiation of the ICIs pembrolizumab and nivolumab. These cases suggest that ICIs can induce both humoral and cell-mediated paraneoplastic neurologic syndromes. Identifying biomarkers that predict risk of developing ICI-associated paraneoplastic syndromes and the development of efficacious treatment strategies for neurologic ICI-toxicities are critical unmet needs.

Placebo-controlled trial to evaluate zidovudine in treatment of human immunodeficiency virus infection in asymptomatic patients with hemophilia. NHF-ACTG 036 Study Group.

One hundred ninety-three asymptomatic patients with hereditary coagulation disorders and human immunodeficiency virus (HIV) infection were studied in a controlled trial of zidovudine (ZDV) versus a placebo (with an average of 9.7 months on study). Pretreatment characteristics were well balanced between the placebo and drug-treated groups, including CD4 distributions, types of clotting disorders, transaminase abnormalities, and use of various hemostatic agents. At the time of analysis, 161 patients either were still receiving treatment or had previously reached an endpoint of disease progression while receiving treatment. Twenty-five patients withdrew voluntarily. The toxic effects noted included granulocytopenia and anemia, especially in older patients, and subjective symptoms of asthenia, malaise, and nausea, consistent with the known consequences of treatment with 300 mg ZDV five times daily. There was a trend toward more diagnoses of acquired immunodeficiency syndrome (AIDS), advanced or early AIDS-related complex (ARC), single ARC symptoms, or death in placebo recipients as compared with those receiving ZDV (22 v 13). Because older patients with hemophilia have more rapid disease progression, the same efficacy analysis was performed in the 89 patients aged more than 30 years who were receiving treatment. In this subgroup, there was a similar trend (11 v 6). With regard to the most advanced problems of the infection among the older patients, there were five patients who were newly diagnosed with AIDS or died in the placebo group versus none in the ZDV group (P = .02) among the older patients. The pretreatment distribution of CD4 counts for the placebo and ZDV groups were similar, but patients aged more than 30 years had significantly (P less than .049) fewer CD4 cells than patients aged less than 30 years. A beneficial ZDV effect is also supported by a trend toward higher CD4 counts (a 48-cell increase in the ZDV group at 24 weeks as compared with a four-cell increase in the placebo group) and a significant (P = .03) difference in weight gain in the ZDV patients aged more than 30 years (8 pounds) as compared with the older placebo patients (aged more than 30 years) (2 pounds) at week 24. The findings in the asymptomatic hemophilic patients aged more than 30 years support a useful effect of ZDV, which is similar to observations in the larger study of its use in asymptomatic, nonhemophilic patients.