Impact of COVID-19 on nationwide pediatric otolaryngology practice: Adenotonsillectomies (TA) and tonsil-related diagnoses trends.

OBJECTIVES/HYPOTHESIS: To determine the effects of the COVID-19 pandemic on Adenotonsillectomies (TA), Tonsil Related Cases (TC), and Peritonsillar Abscess (PTA) Trends. STUDY DESIGN: Retrospective Cohort Study. METHODS: This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 51 children's hospitals. Regions were defined according to PHIS rules with at least five children's hospitals per region. We compared monthly total TA, TC, TC as a proportion of all hospital visits, and PTA from all encounters at each hospital from January 1, 2019, through December 31, 2021. RESULTS: Compared to 2019, April 2020 saw mean TC drop significantly from 371.62 to 68.37 (p < 0.001). Interestingly, June, September, and December 2020 had significantly higher mean TC compared to 2019. TC as a proportion of all hospital visits decreased significantly throughout the majority of 2021. Similarly, TA significantly decreased during 2020 and 2021 across all regions in the US, starting in March 2020 and this reduction in TA extended through the end of 2021 without any signs of recovery. PTA rates did not change significantly over the three years. CONCLUSIONS: The pandemic-plagued 2020 saw a noticeable decrease in overall TC and TA but then rebounded quickly to even higher than pre-pandemic levels. However, this rebound halted for the majority of 2021 and subsequently decreased to lower than pre-pandemic levels, which differs from other communicable pathologies such as otitis media which decreased initially then recovered to pre-pandemic levels by Summer of 2021.

Impact of COVID-19 on nationwide pediatric otolaryngology: Otitis media and myringotomy tube trends.

PURPOSE: The pandemic related to the novel coronavirus (COVID-19) has led to a decrease in communicable diseases due to social distancing and mask-wearing. How have the prevalence of otitis media (OM) and its associated procedures changed during the pandemic? STUDY DESIGN: Retrospective Cohort Study. METHODS: This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 48 children's hospitals. Regions were defined according to PHIS rules. We compared proportion of OM to total diagnoses codes, and collected mastoiditis, and MT placements from all encounters through January 1, 2019-June 31, 2021. RESULTS: In April 2020, there was a decrease in mean proportion of OM cases per 100 hospital visits (7 v. 2, p < 0.0001) and this was sustained through 2020 and until June 2021 (6-7 v. 2-4, p < 0.05; p < 0.05). Compared to 2020, the months of April and June 2021 showed an increase in mean proportion of OM cases (6-7 v. 3-4, p < 0.05) while May did not. This relative increase in OM cases through April-June were primarily driven by the South, the Midwest, and the Northeast in April and the South and the Midwest in June. MT procedures followed similar trends. In 2020, there was no difference in mastoiditis as a proportion of OM cases compared to 2019 however there was a statistically higher rate of mastoiditis in 2020 compared to 2021. CONCLUSIONS: The COVID-19 pandemic led to declines in OM and MT case volumes that have started to increase. A geographic relationship may exist, and this connection could be influenced by mask mandates and social distancing.

Differences in Sociodemographic Correlates of Human Papillomavirus-Associated Cancer Survival in the United States.

OBJECTIVES: Human papillomavirus (HPV)-associated cancers account for about 9% of the cancer mortality burden in the United States; however, survival differs among sociodemographic factors. We determine sociodemographic and clinical variables associated with HPV-associated cancer survival. METHODS: Data derived from the Surveillance, Epidemiology, and End Results 18 cancer registry were analyzed for a cohort of adult patients diagnosed with a first primary HPV-associated cancer (anal, cervical, oropharyngeal, penile, vaginal, and vulvar cancers), between 2007 and 2015. Multivariable Fine and Gray proportional hazards regression models stratified by anatomic site estimated the association of sociodemographic and clinical variables and cancer-specific survival. RESULTS: A total of 77 774 adults were included (11 216 anal, 27 098 cervical, 30 451 oropharyngeal, 2221 penile, 1176 vaginal, 5612 vulvar; average age = 57.2 years). The most common HPV-associated cancer was cervical carcinoma (58%) for females and oropharyngeal (81%) for male. Among patients diagnosed with anal/rectal squamous cell carcinoma (SCC), males had a higher risk of death than females. NonHispanic (NH) blacks had a higher risk of death from anal/rectal SCC, oropharyngeal SCC, and cervical carcinoma; and Hispanics had a higher risk of death from oropharyngeal SCC than NH whites. Marital status was associated with risk of death for all anatomic sites except vulvar. Compared to nonMedicaid insurance, patients with Medicaid and uninsured had higher risk of death from anal/rectal SCC, oropharyngeal SCC, and cervical carcinoma. CONCLUSIONS: There exists gender (anal) and racial and insurance (anal, cervical, and oropharyngeal) disparities in relative survival. Concerted efforts are needed to increase and sustain progress made in HPV vaccine uptake among these specific patient subgroups, to reduce cancer incidence.

Prevalence and factors associated with diagnosed depression among hospitalized cancer patients with metastatic disease.

PURPOSE: This study aimed to examine the factors associated with diagnosed depression among patients with a metastatic cancer. METHODS: We conducted a cross-sectional analysis of 39,223 hospital records from 2008 to 2013 National Inpatient Sample for patients with metastatic cancer. Diagnosed depression was defined using ICD-9-CM for major depression. Weighted, multivariable hierarchical regression model was used to examine the association between sociodemographic and clinical factors and depression among patients with a metastatic cancer. RESULTS: The prevalence of clinically diagnosed depression in patients with a metastatic cancer in our study sample was 7.3% (5.9% for males and 8.6% for females). The prevalence rate of diagnosed depression increased from 5.3 to 9.4% between 2008 and 2013. In multivariable analysis, patients were more likely to be diagnosed with depression if they were females (aOR = 1.44; 95% CI 1.25-1.66) compared to males; and had higher number of comorbidities (aOR = 1.11 per 1-unit increase in Elixhauser comorbidity score, 95% CI 1.07-1.15). In contrast, patients were less likely to be diagnosed with depression if they were blacks (aOR = 0.59; 95% CI 0.47-0.74) or other race (aOR = 0.58; 95% CI 0.47-0.72) compared with white patients. CONCLUSIONS: Women and individuals with more comorbidities were diagnosed with depression more frequently, whereas black patients were diagnosed less. Our findings could help providers to identify hospitalized patients with the higher risk of depression and screened patients with signs and symptoms of clinical depression.

Nanoscale reorganizations of histone-like nucleoid structuring proteins in Escherichia coli are caused by silver nanoparticles.

Silver nanoparticles (AgNPs) and ions (Ag+) have recently gained broad attention due to their antimicrobial effects against bacteria and other microbes. In this work, we demonstrate the use of super-resolution fluorescence microscopy for investigating and quantifying the antimicrobial effect of AgNPs at the molecular level. We found that subjecting Escherichia coli (E. coli) bacteria to AgNPs led to nanoscale reorganization of histone-like nucleoid structuring (H-NS) proteins, an essential nucleoid associated protein in bacteria. We observed that H-NS proteins formed denser and larger clusters at the center of the bacteria after exposure to AgNPs. We quantified the spatial reorganizations of H-NS proteins by examining the changes of various spatial parameters, including the inter-molecular distances and molecular densities. Clustering analysis based on Voronoi-tessellation were also performed to characterize the change of H-NS proteins' clustering behavior. We found that AgNP-treatment led to an increase in the fraction of H-NS proteins forming clusters. Similar effects were observed for bacteria exposed to Ag+ ions, suggesting that the release of Ag+ ions plays an important role in the toxicity of AgNPs. On the other hand, we observed that AgNPs with two surface coatings showed difference in the nanoscale reorganization of H-NS proteins, indicating that particle-specific effects also contribute to the antimicrobial activities of AgNPs. Our results suggested that H-NS proteins were significantly affected by AgNPs and Ag+ ions, which has been overlooked previously. In addition, we examined the dynamic motion of AgNPs that were attached to the surface of bacteria. We expect that the current methodology can be readily applied to broadly and quantitatively study the spatial reorganization of biological macromolecules at the scale of nanometers caused by metal nanoparticles, which are expected to shed new light on the antimicrobial mechanism of metal nanoparticles.

Survival differences in nasopharyngeal carcinoma among racial and ethnic minority groups in the United States: A retrospective cohort study.

OBJECTIVE: The literature on nasopharyngeal carcinoma survival in the United States has focused mostly on Whites or Asians and not much is known about survivorship in other minority racial and ethnic groups. We aimed to determine the disease-specific survival rate and prognostic factors for nasopharyngeal carcinoma survival across the minority United States population. DESIGN: A retrospective cohort study. SETTING: The Surveillance, Epidemiology and End Results (SEER) 13 database from 1992 to 2014 was queried for adult cases of nasopharyngeal carcinoma (n = 2549). PARTICIPANTS: Eligible cases were Blacks, Hispanics, Asians/Pacific Islanders, American Indians/Alaska Natives; White patients were excluded. MAIN OUTCOMES MEASURE: A multivariable competing risk survival analysis yielded hazard ratios (HR) for competing mortality and was used to identify independent prognostic factors for survival. RESULTS: Non-Hispanic American Indians/Alaska Natives consistently had the worst cause-specific survival of any group and that non-Hispanic Asians/Pacific Islanders consistently had the best survival (P < 0.001). Even after adjusting for other poor prognostic factors in the study, including older age, keratinising histology, and lack of radiation treatment, non-Hispanic American Indians/Alaska Natives had more than double hazards of death from nasopharyngeal cancer compared with non-Hispanic Asians/Pacific Islanders (aHR = 2.63, 95% CI 1.67, 4.13). CONCLUSIONS: There are disparities in nasopharyngeal carcinoma survival among racial and ethnic minority groups in the United States, with American Indians/Alaskan Natives faring worst. It is critical that future research focuses on nasopharyngeal carcinoma among this population to improve survivorship and mitigate cancer-related health disparities.

Prevalence and sociodemographic factors associated with depression among hospitalized patients with head and neck cancer-Results from a national study.

OBJECTIVE: Depression is a significant problem for patients with head and neck cancer (HNC). This study explored the prevalence of and sociodemographic and clinical factors associated with depression, among patients with HNC. METHODS: We performed a retrospective analysis of 71 541 cases of HNC using a national dataset, the Nationwide Inpatient Sample, from 2008 to 2013. Weighted, multivariate logistic regression analysis estimated association between sociodemographic/clinical factors and tumor anatomical site with diagnosis of a major depressive disorder. RESULTS: Overall prevalence of major depressive disorder in HNC was 9.3%; highest prevalence was found in patients with laryngeal cancer (28.5%). Compared with laryngeal cancer, there were lower odds of depression among patients with oral cavity cancer (adjusted odds ratio [aOR] = 0.90; 95% CI, 0.84-0.97) and other anatomic sites (aOR = 0.87; 95% CI, 0.81-0.94), except oropharyngeal cancer (aOR = 1.00; 95% CI, 0.93-1.08). For every unit increase in comorbidities, odds of depression increased by 20% (aOR = 1.20; 95% CI, 1.19-1.23). Sociodemographic factors associated with increased odds of depression included being female (aOR = 1.77; 95% CI, 1.68-1.87), white (aOR = 1.75; 95% CI, 1.59-1.92), and having Medicaid (aOR = 1.09; 95% CI, 1.01-1.19) or Medicare insurance (aOR = 1.19; 95% CI, 1.10-1.27). CONCLUSIONS: Depression odds vary depending on HNC anatomic site, and one in four patients with laryngeal cancer may be depressed. Since depression is prevalent in this survivor cohort, it is important that psychosocial assessment and intervention are integrated into mainstream clinical care for patients with HNC.

Invasive Cytomegalovirus (CMV) Sinusitis in an Acquired Immunodeficiency Syndrome (AIDS) Patient.

A patient with acquired immunodeficiency syndrome presented with findings concerning for acute invasive fungal sinusitis, which is typically associated with Mucorales. However, debridement and pathological analysis revealed Cytomegalovirus, a pathology rarely encountered. Laryngoscope, 134:92-96, 2024.

The Use of Acellular Human Dermis as a Dorsal Camouflaging Graft in Rhinoplasty.

Background: Acellular human dermis (AHD) has many uses in rhinoplasty, but its long-term use as a camouflaging graft has not been adequately described. Objective: To measure the long-term outcomes (infections/contour irregularities) of AHD used as a camouflage graft in rhinoplasty. Methods: A retrospective study of 91 patients who underwent rhinoplasty requiring AHD as a camouflage graft for a 20-year time period (2000-2020) was performed. Complications, revisions, and long-term outcomes were assessed. Surgical technique for AHD use as a dorsal and tip camouflage graft was described in detail and illustrated using intraoperative photography. Results: Of the 91 patients who required AHD in their rhinoplasties, 70 (77%) were performed in revision cases to thicken thinned and scarred skin envelopes. Only 1% had postoperative contour problems that were attributable to AHD, and only 3% had resorption of the AHD. Four percent had postoperative infections, all of which resolved with a single course of oral antibiotics. Patients were followed a mean of 3.8 years. Conclusions: AHD can be a safe, effective, and readily available option for use in thickening the nasal skin envelope in rhinoplasty.

Sun protective behaviors among adolescents and young adults in the United States.

PURPOSE: We described sun protective behaviors in adolescents and young adults (AYA) compared to older adults. METHODS: We used data from the 2013-2018 National Health and Nutrition Examination Survey, a nationally representative samples of the civilian, noninstitutionalized US population (10,710 respondents aged between 20 and 59 and without a history of skin cancer diagnoses). The primary exposure for the study was age group: aged 20-39 defined as AYA and aged 40-59 as adults. The outcome variable was sun protective behaviors: stay in the shade, wear a long-sleeved shirt, use sunscreen, at least one of the three; and all three measures. Multivariable logistic regression models were used to assess association between age group and sun protective behaviors adjusting for sociodemographic factors. RESULTS: Overall, 51.3% of respondents were AYA, 76.1% reported staying in the shade, 50.9% using sunscreen, 33.3% wearing long-sleeved clothes, 88.1% engaging in one of the three behaviors, and 17.1% engaging in all three behaviors. In the adjusted models, the odds of engaging in all three behaviors among AYAs was 28% (aOR: 0.72, 95% CI: 0.62-0.83) lower than adult respondents. Compared to adults, AYAs were 22% less likely to wear long sleeved clothes (aOR: 0.78, 95% CI: 0.70-0.87). There were no significant differences in the odds of engaging in at least one sun protective behavior, using sunscreen, and staying in the shade between AYAs and adults. CONCLUSIONS: More targeted interventions need to be implemented to decrease the risk of skin cancer in the AYA population.

The role of fungus in the pathogenesis of chronic rhinosinusitis.

PURPOSE OF REVIEW: The etiologic role of fungi in chronic rhinosinusitis remains controversial. The purpose of this review is to further our understanding of molecular immunologic pathways activated by fungi and clinical trials of antifungals in severe subtypes of asthma and allergic fungal rhinosinusitis. RECENT FINDINGS: Various fungal components such as protease and chitin are capable of eliciting a type 2 innate and adaptive immune response. However, definitive studies on the etiologic role of fungi in chronic rhinosinusitis (CRS) is dependent on the development of a fungi-induced murine model of CRS. Short of this model, extrapolations of observations and results from clinical trials in fungi-induced asthma subtypes support a key role of fungi in the pathophysiology of allergic fungal rhinosinusitis and possibly other CRS endotypes. SUMMARY: Fungi plays a key role in the pathophysiology of several subtypes of chronic inflammatory respiratory diseases. However, a fungi-induced murine model of CRS is needed to explicitly investigate the molecular pathways and potential therapeutic targets.

Survival outcomes for head and neck patients with Medicaid: A health insurance paradox.

PURPOSE: Privately insured patients with head and neck cancer (HNC) typically have better outcomes; however, differential outcome among Medicaid versus the uninsured is unclear. We aimed to describe outcome disparities among HNC patients uninsured versus on Medicaid. METHODS: A cohort of 18-64-year-old adults (n = 57 920) with index HNC from the Surveillance, Epidemiology, and End Results 18 database (2007-2015) was analyzed using Fine and Gray multivariable competing risks proportional hazards models for HNC-specific mortality. RESULTS: Medicaid (sdHR = 1.65, 95% CI 1.58, 1.72) and uninsured patients (sdHR = 1.55, 95% CI 1.46, 1.65) had significantly greater mortality hazard than non-Medicaid patients. Medicaid patients had increased HNC mortality hazard than those uninsured. CONCLUSION: Compared with those uninsured, HNC patients on Medicaid did not have superior survival, suggesting that there may be underlying mechanisms/factors inherent in this patient population that could undermine access to care benefits from being on Medicaid.

Multilevel Associations Between Patient- and Hospital-Level Factors and In-Hospital Mortality Among Hospitalized Patients With Head and Neck Cancer.

Importance: Risk factors for in-hospital mortality of patients with head and neck cancer (HNC) are multilevel. Studies have examined the effect of patient-level characteristics on in-hospital mortality; however, there is a paucity of data on multilevel correlates of in-hospital mortality. Objective: To examine the multilevel associations of patient- and hospital-level factors with in-hospital mortality and develop a nomogram to predict the risk of in-hospital mortality among patients diagnosed with HNC. Design, Setting, and Participants: This cross-sectional study used the 2008-2013 National Inpatient Sample database. Hospitalized patients 18 years and older diagnosed (both primary and secondary diagnosis) as having HNC using the International Classification of Diseases, Ninth Revision, Clinical Modification codes were included. Analysis began December 2018. Main Outcomes and Measures: The primary outcome of interest was in-hospital mortality. A weighted multivariable hierarchical logistic regression model estimated patient- and hospital-level factors associated with in-hospital mortality. Moreover, a multivariable logistic regression analysis was used to build an in-hospital mortality prediction model, presented as a nomogram. Results: A total of 85 440 patients (mean [SD] age, 62.2 [13.5] years; 61 281 men [71.1%]) were identified, and 4.2% (n = 3610) died in the hospital. Patient-level risk factors associated with higher odds of in-hospital mortality included age (adjusted odds ratio [aOR], 1.03 per 1-year increase; 95% CI, 1.02-1.03), male sex (aOR, 1.23; 95% CI, 1.12-1.35), higher number of comorbidities (aOR, 1.14; 95% CI, 1.11-1.17), having a metastatic cancer (aOR, 1.49; 95% CI, 1.36- 1.64), having a nonelective admission (aOR, 3.26; 95% CI, 2.83-3.75), and being admitted to the hospital on a weekend (aOR, 1.30; 95% CI, 1.16-1.45). Of the hospital-level factors, admission to a nonteaching hospital (aOR, 1.48; 95% CI, 1.24-1.77) was associated with higher odds of in-hospital mortality. The nomogram showed fair in-hospital mortality discrimination (area under the curve of 72%). Conclusions and Relevance: This cross-sectional study found that both patient- and hospital-level factors were associated with in-hospital mortality, and the nomogram estimated with fair accuracy the probability of in-hospital death among patients with HNC. These multilevel factors are critical indicators of survivorship and should thus be considered when planning programs or interventions aimed to improve survival among this unique population.

Sociodemographic correlates of head and neck cancer survival among patients with metastatic disease.

BACKGROUND: To describe sociodemographic factors associated with head and neck cancer (HNC) survival among patients with distant metastatic disease. METHODS: We retrospectively analyzed national data for 2889 adult patients with metastatic HNC (2007-2015). We used Fine and Gray competing risks proportional hazard models, stratified by oropharyngeal cancer status, controlled for sociodemographic factors (age, sex, race/ethnicity, marital status, and insurance status), and accounted for multiple testing. RESULTS: Median survival time was 11 months (15 months for patients married/partnered; 13 months for patients with non-Medicaid insurance; P < .01). Among patients with oropharyngeal cancer, being married/partnered was associated with lower mortality hazard (sdHRdivorced/separated = 1.37, 97.5% confidence interval [CI] = 1.07, 1.75; and sdHRnever married = 1.43, 97.5% CI = 1.14, 1.80), as was having non-Medicaid insurance (sdHRuninsured = 1.44, 97.5% CI = 1.02, 2.04). CONCLUSIONS: Health insurance and marital status are sociodemographic factors associated with survival among HNC patients with distant metastatic disease, especially in oropharyngeal cases.

Demographic predictors of head and neck cancer survival differ in the elderly.

OBJECTIVES/HYPOTHESIS: Head and neck squamous cell carcinoma (HNSCC) prognosis strongly correlates with demographic factors. This study aimed to determine whether demographic predictors of HNSCC survival differ between age cohorts, with an emphasis on the growing elderly demographic. STUDY DESIGN: Outcomes research. METHODS: Adults with squamous cell carcinoma of the upper aerodigestive tract were identified from the Surveillance, Epidemiology and End Results 18 database. Demographic and oncologic factors were compared between three age groups: 18 to 49, 50 to 74, and >75 years. Factors associated with cancer-specific survival were assessed in each cohort using subdistribution hazard ratio (sHR) and 95% confidence interval (CI) produced by multivariate competing risk models. RESULTS: A cohort of 69,098 patients included 10,588 (15.3%) 75 years or older and 9,882 (14.3%) less than 50 years old. Older patients were more often female (35.4% vs. 25.1% aged 18-49 years and 20.4% aged 50-74 years), white (78.7% vs. 69.4% and 75.9%), insured (63.5% vs. 46.5% and 56.8%), and married (56.6% vs. 53% and 51.1%), but received adequate treatment less often (72.0% vs. 86.3% and 82.7%). In the older cohort, male sex was associated with lower mortality (sHR: 0.92, 95% CI: 0.85-1.00), and unlike the younger cohorts, black race was no longer associated with mortality (sHR: 1.07, 95% CI: 0.94-1.22). Marriage was associated with lower mortality in all age groups but with diminishing effects (single sHR: young 1.52, middle 1.31, older 1.14). CONCLUSIONS: Elderly HNSCC patients have distinct effects from demographic prognostic factors and should be considered a separate subgroup with unique epidemiology, risks, and preferences. LEVEL OF EVIDENCE: 2c Laryngoscope, , 129:146-153, 2018.

Impact of gender on the association between marital status and head and neck cancer outcomes.

OBJECTIVES: To determine whether the impact of marital status on head and neck cancer (HNC) outcomes vary by gender. METHODS: The Surveillance, Epidemiology, and End Results 18 database from 2007 to 2014 was queried for eligible cases of HNC (n = 71,799). An interaction term (gender*marital status) was tested for each outcome of interest (cancer-specific survival, stage of presentation, adequate treatment), and when significant (p < 0.05), the model was stratified by gender. A competing risks proportional hazards (subdistribution [sd]) model estimated the interaction effect on cancer-specific survival. Logistic regression estimated effect on stage of presentation and treatment type. RESULTS: There was significant gender*marital status interaction for cancer-specific survival and stage of presentation. While married/partnered patients had the highest survival among both genders, males benefitted more: widowed (male sdHR = 1.41, 95% CI 1.31, 1.52; female sdHR = 1.15, 95% CI 1.06, 1.26), divorced/separated (males: sdHR = 1.39, 95% CI 1.32, 1.46; females: sdHR = 1.17, 95% CI 1.06, 1.28), or never married (males: sdHR = 1.42, 95% CI 1.36, 1.49; females: sdHR = 1.15, 95% CI 1.05, 1.26). When stratified by oropharyngeal cancer vs. non-oropharyngeal HNC, unmarried males had 50-60% increased hazard of death, while no difference was found for females. Unmarried males also had greater odds of presenting with late-stage disease compared with females. No gender*marital status interaction was observed for adequate treatment, although married/partnered survivors had greater odds of receiving adequate treatment. CONCLUSIONS: While there are survival benefits for married patients with HNC, married/partnered males, especially those with oropharyngeal cancer, may benefit more than females.

Head and Neck Squamous Cell Carcinoma in Adolescents and Young Adults: Survivorship Patterns and Disparities.

PURPOSE: Adolescent and young adult (AYA) head and neck cancer (HNC) patients require longer term follow-ups as they age; yet, little is known about factors associated with survivorship in this population. We aimed to describe nonclinical factors associated with HNC survivorship among AYAs. METHODS: In this retrospective cohort study, the Surveillance, Epidemiology and End Results 18 database from 2007 to 2014 was queried. Eligible cases were 15-39-year-old primary HNC patients with known cause of death (n = 1777). Kaplan-Meier survival curves stratified by age group (15-29, 30-34, and 35-39) and by health insurance status tested differences in HNC survival among groups with a log-rank test. Variables, including age, sex, race/ethnicity, county-level poverty, anatomic site, stage, and treatment, were controlled for in a competing risk proportional hazards model. RESULTS: Patients were mostly male (64%), with mean age of 33.4 years. Survival rate was 73% after 8 years of follow-up. There were no significant survival differences based on age at diagnosis. However, AYAs who were on Medicaid (adjusted hazard ratio [aHR] = 1.61, 95% confidence interval [CI] 1.22-2.12) or uninsured (aHR = 1.51, 95% CI 1.03-2.21), had an increased hazard of death from HNC, compared with those with private insurance. CONCLUSION: Health insurance status is the main nonclinical factor associated with survival among AYAs with HNC, and individuals with Medicaid do not fare better than the uninsured. With a potential longer term follow-up in this AYA population, there is need to optimize survivorship irrespective of health insurance status.

Robust nonparametric quantification of clustering density of molecules in single-molecule localization microscopy.

We report a robust nonparametric descriptor, J'(r), for quantifying the density of clustering molecules in single-molecule localization microscopy. J'(r), based on nearest neighbor distribution functions, does not require any parameter as an input for analyzing point patterns. We show that J'(r) displays a valley shape in the presence of clusters of molecules, and the characteristics of the valley reliably report the clustering features in the data. Most importantly, the position of the J'(r) valley ([Formula: see text]) depends exclusively on the density of clustering molecules (ρc). Therefore, it is ideal for direct estimation of the clustering density of molecules in single-molecule localization microscopy. As an example, this descriptor was applied to estimate the clustering density of ptsG mRNA in E. coli bacteria.