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Background: a well-known complication of laparoscopic management of gynaecologic masses and cancers is the need to perform an intraoperative conversion to laparotomy. The purpose of this study was to identify novel patient risk factors for conversion from minimally invasive to open surgeries for gynaecologic oncology operations. Methods: This was a retrospective cohort study of 1356 patients ≥18 years of age who underwent surgeries for gynaecologic masses or malignancies between February 2015 and May 2020 at a single academic medical centre. Multivariable logistic regression was used to study the effects of older age, higher body mass index (BMI), higher american Society of anaesthesiologist (ASA) physical status, and lower preoperative haemoglobin (Hb) on odds of converting from minimally invasive to open surgery. Receiver operating characteristic (ROC) curve analysis assessed the discriminatory ability of a risk prediction model for conversion. Results: a total of 704 planned minimally invasive surgeries were included with an overall conversion rate of 6.1% (43/704). Preoperative Hb was lowest for conversion cases, compared to minimally invasive and open cases (11.6±1.9 vs 12.8±1.5 vs 11.8±1.9g/dl, p<.001). Patients with preoperative Hb <10g/dl had an adjusted odds ratio (OR) of 3.94 (ci: 1.65--9.41, p=.002) for conversion while patients with BMI ≥30kg/m² had an adjusted OR of 2.86 (ci: 1.50--5.46, p=.001) for conversion. Roc curve analysis using predictive variables of age >50years, BMi ≥30kg/m², ASA physical status >2, and preoperative haemoglobin <10g/dl resulted in an area under the Roc curve of 0.71. Patients with 2 or more risk factors were at highest risk of requiring an intraoperative conversion (12.0%). Conclusions: lower preoperative haemoglobin is a novel risk factor for conversion from minimally invasive to open gynaecologic oncology surgeries and stratifying patients based on conversion risk may be helpful for preoperative planning. [ABSTRACT FROM AUTHOR]

Background and Objectives: Greater lifetime exposure to psychological trauma correlates with a higher number of health comorbidities and negative health outcomes. However, physicians often are not specifically trained in how to care for patients with trauma, especially in acute care settings. Our objective was to identify implemented trauma-informed care (TIC) training protocols for emergency and/or trauma service physicians that have both sufficient detail that they can be adapted and outcome data indicating positive impact. Methods:Weconducted a comprehensive literature search in MEDLINE (Ovid), Scopus, PsycInfo, Web of Science, Cochrane Library, Ebsco's Academic Search Premier, and MedEdPORTAL. Inclusion criteria were EM and trauma service clinicians (medical doctors, physician assistants and nurse practitioners, residents), adult and/or pediatric patients, and training evaluation. Evaluation was based on the Kirkpatrick Model. Results: We screened 2,280 unique articles and identified two different training protocols. Results demonstrated the training included patient-centered communication and interprofessional collaboration. One curriculum demonstrated that targeted outcomes were due to the training (Level 4). Both curricula received overall positive reactions (Level 1) and illustrated behavioral change (Level 3). Neither were found to specifically illustrate learning due to the training (Level 2). Conclusion: Study findings from our review show a paucity of published TIC training protocols that demonstrate positive impact and are described sufficiently to be adopted broadly. Current training protocols demonstrated an increasing comfort level with the TIC approach, integration into current practices, and referrals to trauma intervention specialists. [ABSTRACT FROM AUTHOR]

Arrestins were discovered for their role in homologous desensitization of G‐protein‐coupled receptors (GPCRs). Later non‐visual arrestins were shown to regulate several signaling pathways. Some of these pathways require arrestin binding to GPCRs, the regulation of others is receptor independent. Here, we demonstrate that arrestin‐3 binds the E3 ubiquitin ligase parkin via multiple sites, preferentially interacting with its RING0 domain. Identification of the parkin domains involved suggests that arrestin‐3 likely relieves parkin autoinhibition and/or stabilizes the enzymatically active “open” conformation of parkin. Arrestin‐3 binding enhances ubiquitination by parkin of the mitochondrial protein mitofusin‐1 and facilitates parkin‐mediated mitophagy in HeLa cells. Furthermore, arrestin‐3 and its mutant with enhanced parkin binding rescue mitofusin‐1 ubiquitination and mitophagy in the presence of the Parkinson's disease‐associated R275W parkin mutant, which is defective in both functions. Thus, modulation of parkin activity via arrestin‐3 might be a novel strategy of anti‐parkinsonian therapy. [ABSTRACT FROM AUTHOR]

Objectives. To compare health insurance coverage and access to care by sex and sexual minority status during the COVID-19 pandemic and assess whether lack of insurance hindered access to care by sexual minority status. Methods. Using Behavioral Risk Factor Surveillance System data (January 2021–February 2022), we examined differences by sex and sexual orientation among 158 722 adults aged 18 to 64 years living in 34 states. Outcomes were health insurance coverage type and 3 access to care measures. Results. Sexual minority women were significantly more likely to be uninsured than were heterosexual women, and lack of insurance widened the magnitude of disparity by sexual minority status in all measures of access. Compared with heterosexual men with health insurance, sexual minority men with health insurance were significantly more likely to report being unable to afford necessary care. Conclusions. During the pandemic, 1 in 8 sexual minority adults living in 34 study states were uninsured. Among sexual minority women, lack of insurance widened inequities in access to care. There were inequities among sexual minority men with health insurance. Public Health Implications. Sexual minority adults may be disproportionately affected by the unwinding of the COVID-19 public health emergency and may require tailored efforts to mitigate insurance coverage loss. (Am J Public Health. 2024;114(1):118–128. https://doi.org/10.2105/AJPH.2023.307446) [ABSTRACT FROM AUTHOR]

The null conformal boundary I of Minkowski spacetime M plays a special role in scattering theory, as it is the locus where massless particle states are most naturally defined. We construct quantum fields on I , which create these massless states from the vacuum and transform covariantly under Poincaré symmetries. Because the latter symmetries act as Carrollian conformal isometries of I , these quantum fields are Carrollian conformal fields. This group theoretic construction is intrinsic to I by contrast to existing treatments in the literature. However, we also show that the standard relativistic massless quantum fields in M , when pulled back to I , provide a realisation of these Carrollian conformal fields. This correspondence between bulk and boundary fields should constitute a basic entry in the dictionary of flat holography. Finally, we show that I provides a natural parametrisation of the massless particles as described by irreducible representations of the Poincaré group and that in an appropriate conjugate basis, they indeed transform like Carrollian conformal fields. [ABSTRACT FROM AUTHOR]

This Viewpoint explores Centers for Medicare & Medicaid Services guidance on the collection of sexual orientation and gender identity data and how these data could be used to advance health equity for LGBTQI+ people. [ABSTRACT FROM AUTHOR]

An effective theory designed to compute Virasoro identity blocks at large central charge, expressed in terms of the propagation of a reparametrization/shadow mode between bilocal vertices, was recently put forward. In this paper I provide the formal theoretical framework underlying this effective theory by reformulating it in terms of standard concepts: conformal geometry, generating functionals and Feynman diagrams. A key ingredient to this formalism is the bilocal vertex operator, or reparametrized two-point function, which is shown to generate arbitrary stress tensor insertions into a two-point function of reference. I also suggest an extension of the formalism designed to compute generic Virasoro blocks. [ABSTRACT FROM AUTHOR]

Key Points: Question: How did enrollment in Medicare Advantage among beneficiaries with end-stage renal disease (ESRD) change after the implementation of the 21st Century Cures Act (which allowed enrollment de novo in Medicare Advantage for patients with ESRD), and what were the characteristics of Medicare beneficiaries with ESRD who switched from traditional Medicare to Medicare Advantage? Findings: In this cross-sectional study of 575 797 Medicare beneficiaries with ESRD, the proportion enrolled in Medicare Advantage increased by 51%. Increases were largest among Black, Hispanic, and dual-eligible (Medicare and Medicaid) beneficiaries. Meaning: Among people with ESRD, increases in Medicare Advantage enrollment in the first year after implementation of the 21st Century Cures Act were substantial, particularly among dual-eligible beneficiaries and those from racial or ethnic minority populations. Importance: Before 2021, most Medicare beneficiaries with end-stage renal disease (ESRD) were unable to enroll in private Medicare Advantage (MA) plans. The 21st Century Cures Act permitted these beneficiaries to enroll in MA plans effective January 2021. Objective: To examine changes in MA enrollment among Medicare beneficiaries with ESRD after enactment of the 21st Century Cures Act overall and by race or ethnicity and dual-eligible status. Design, Setting, and Participants: This cross-sectional time-trend study used data from Medicare beneficiaries with ESRD (both kidney transplant recipients and those undergoing dialysis) between January 2019 and December 2021. Data were analyzed between June and October 2022. Exposures: 21st Century Cures Act. Main Outcomes and Measures: Primary outcomes were the proportion of Medicare beneficiaries with prevalent ESRD who switched from traditional Medicare to MA between 2020 and 2021 and those with incident ESRD who newly enrolled in MA in 2021. Individuals who stayed in traditional Medicare were enrolled in 2020 and 2021 and those who switched to MA were enrolled in traditional Medicare in 2020 and MA in 2021. Results: Among 575 797 beneficiaries with ESRD in 2020 or 2021 (mean [SD] age, 64.7 [14.2] years, 42.2% female, 34.0% Black, and 7.7% Hispanic or Latino), the proportion of beneficiaries enrolled in MA increased from 24.8% (December 2020) to 37.4% (December 2021), a relative change of 50.8%. The largest relative increases in MA enrollment were among Black (72.8% relative increase), Hispanic (44.8%), and dual-eligible beneficiaries with ESRD (73.6%). Among 359 617 beneficiaries with TM and prevalent ESRD in 2020, 17.6% switched to MA in 2021. Compared with individuals who stayed in traditional Medicare, those who switched to MA had modestly more chronic conditions (6.3 vs 6.1; difference, 0.12 conditions [95% CI, 0.10-0.16]) and similar nondrug spending in 2020 (difference, $509 [95% CI, −$58 to $1075]) but were more likely to be Black (difference, 19.5 percentage points [95% CI, 19.1-19.9]) and have dual Medicare-Medicaid eligibility (difference, 20.8 percentage points [95% CI, 20.4-21.2]). Among beneficiaries who were newly eligible for Medicare ESRD benefits in 2021, 35.2% enrolled in MA. Conclusions and Relevance: Results suggest that increases in MA enrollment among Medicare beneficiaries with ESRD were substantial the first year after the 21st Century Cures Act, particularly among Black, Hispanic, and dual-eligible individuals. Policy makers and MA plans may need to assess network adequacy, disenrollment, and equity of care for beneficiaries who enrolled in MA. This cross-sectional study uses data from Medicare beneficiaries with ESRD (kidney transplant recipients and those undergoing dialysis) to examine changes in Medicare Advantage enrollment after enactment of the 21st Century Cures Act overall, by race and ethnicity, and by dual-eligible status. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis (M. tb). When M. tb disseminates to the vertebral column, it is called Pott's disease or spinal TB. The frequency, symptoms, and severity of the disease range by the location of the spine and the region of the affected vertebrae. While the current literature shows that timely diagnosis is crucial to reduce the morbidity and mortality from Pott's disease, there is a lack of specific clinical diagnostic criteria for Pott's disease, and the symptoms may be very non-specific. Studies have shown that novel molecular diagnostic methods are effective and timely choices. Research has implicated the risk factors for the susceptibility and severity of Pott's disease, such as HIV and immunosuppression, poverty, and malnutrition. Based on the current literature available, our group aims to summarize the pathogenesis, clinical features, diagnostic challenges, as well as the known risk factors for Pott's disease within this literature review. [ABSTRACT FROM AUTHOR]

Anti-immigrant public policies and rhetoric during 2017-19 may have eroded enrollment in safety-net programs, such as the enrollment of children of immigrants in the Supplemental Nutrition Assistance Program (SNAP). At the same time, states' expansion of Medicaid through the Affordable Care Act may have mitigated erosion through coordinated enrollment across safety-net programs, including SNAP and Medicaid. We examined changes in SNAP participation rates by parental immigration status among low-income households in 2015-16 versus 2017-19 for differences by child race and ethnicity or state Medicaid expansion status. Relative to those among citizen children with US-born parents, SNAP participation rates among citizen children from mixed-status families and noncitizen children significantly decreased between 2015-16 and 2017-19, with the magnitude of disparity widening over time. Declines in SNAP participation were sharper for Hispanic and Latino children from mixed-status families, Hispanic and Latino noncitizen children, and noncitizen children residing in nonexpansion states. Findings are consistent with some policy makers' concerns of erosion in SNAP participation. Mechanisms that could be employed to help reverse these trends include policies, outreach strategies, and enrollment processes. [ABSTRACT FROM AUTHOR]

Recent genome wide association studies have identified 89 common genetic variants robustly associated with ischemic stroke and primarily located in non-coding regions. To evaluate the contribution of coding variants, which are mostly rare, we performed an exome array analysis on 106,101 SNPs for 9721 ischemic stroke cases from the SiGN Consortium, and 12,345 subjects with no history of stroke from the Health Retirement Study and SiGN consortium. We identified 15 coding variants significantly associated with all ischemic stroke at array-wide threshold (i.e., p < 4.7 × 10−7), including two common SNPs in ABO that have previously been associated with stroke. Twelve of the remaining 13 variants were extremely rare in European Caucasians (MAF < 0.1%) and the associations were driven by African American samples. There was no evidence for replication of these associations in either TOPMed Stroke samples (n = 5613 cases) or UK Biobank (n = 5874 stroke cases), although power to replicate was very low given the low allele frequencies of the associated variants and a shortage of samples from diverse ancestries. Our study highlights the need for acquiring large, well-powered diverse cohorts to study rare variants, and the technical challenges using array-based genotyping technologies for rare variant genotyping. [ABSTRACT FROM AUTHOR]

We compute the conserved charges associated with the asymptotic symmetries of massless particles by examining their free theory in Minkowski space–time. We give a procedure to systematically deduce the fall off of the massless fields at spatial infinity and show that it has a universal behavior when expressed in tangent space. We do this for generic massless particles. We do not impose gauge fixing conditions, which will allow us to uncover new nonzero charges for the graviton beyond the well-known supertranslation charges. We also compute conserved charges in the dual formulations of certain low-spin particles and argue that this leads to an infinite number of new conserved charges. [ABSTRACT FROM AUTHOR]

The application of Polyvinylidene Fluoride or Polyvinylidene Difluoride (PVDF) in harvesting energy from tire deformation was investigated in this study. An instrumented tire with different sizes of PVDF-based piezoelectric patches and a tri-axial accelerometer attached to its inner liner was used for this purpose and was tested under different conditions on asphalt and concrete surfaces. The results demonstrated that on both pavement types, the generated voltage was directly proportional to the size of the harvester patches, the longitudinal velocity, and the normal load. Additionally, the generated voltage was inversely proportional to the tire inflation pressure. Moreover, the range of generated voltages was slightly higher on asphalt compared to the same testing conditions on the concrete surface. Based on the results, it was concluded that in addition to the potential role of the PVDF-based piezoelectric film in harvesting energy from tire deformation, they demonstrate great potential to be used as self-powered sensors to estimate the tire-road contact parameters. [ABSTRACT FROM AUTHOR]

The constrained Hamiltonian analysis of geometric actions is worked out before applying the construction to the extended Bondi-Metzner-Sachs group in four dimensions. For any Hamiltonian associated with an extended BMS4 generator, this action provides a field theory in two plus one spacetime dimensions whose Poisson bracket algebra of Noether charges realizes the extended BMS4 Lie algebra. The Poisson structure of the model includes the classical version of the operator product expansions that have appeared in the context of celestial holography. Furthermore, the model reproduces the evolution equations of non-radiative asymptotically flat spacetimes at null infinity. [ABSTRACT FROM AUTHOR]

Hypoxia–ischemia (HI)-related brain injury is an important cause of morbidity and long-standing disability in newborns. We have previously shown that human plasma-derived inter-alpha inhibitor proteins (hIAIPs) attenuate HI-related brain injury in neonatal rats. The optimal dose of hIAIPs for their neuroprotective effects and improvement in behavioral outcomes remains to be determined. We examined the efficacy of 30, 60, or 90 mg/kg of hIAIPs administered to neonatal rats after exposure to HI for 2 h. Postnatal day 7 (P7) Wistar rats were exposed to either sham-surgery or unilateral HI (right carotid artery ligation, 2 h of 8% O2) brain injury. A placebo, 30, 60, or 90 mg/kg of hIAIPs were injected intraperitoneally at 0, 24 and 48 h after HI (n = 9–10/sex). We carried out the following behavioral analyses: P8 (righting reflex), P9 (negative geotaxis) and P10 (open-field task). Rats were humanely killed on P10 and their brains were stained with cresyl violet. Male extension/contraction responses and female righting reflex times were higher in the HI placebo groups than the sham groups. Female open-field exploration was lower in the HI placebo group than the sham group. hIAIPs attenuated these behavioral deficits. However, the magnitude of the responses did not vary by hIAIP dose. hIAIPs reduced male brain infarct volumes in a manner that correlated with improved behavioral outcomes. Increasing the hIAIP dose from 30 to 90 mg/kg did not further accentuate the hIAIP-related decreases in infarct volumes. We conclude that larger doses of hIAIPs did not provide additional benefits over the 30 mg/kg dose for behavior tasks or reductions in infarct volumes in neonatal rats after exposure to severe HI. [ABSTRACT FROM AUTHOR]

Collection of data for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) persons that is disaggregated by ethnic subgroup may identify disparities that are not apparent in aggregated data. Using content analysis, we identified national population surveys administered by the US Department of Health and Human Services (HHS) and evaluated trends in the collection of disaggregated AANHPI data between 2011 and 2021. In 2011, 4 of 15 surveys (27%) collected disaggregated data for Asian American, 2 of 15 surveys (13%) collected data on Native Hawaiian, and 2 of 15 surveys (13%) collected disaggregated data for Pacific Islander people. By 2019, 14 of 21 HHS-administered surveys (67%) collected disaggregated data for Asian American (6 subgroups), 67% collected data on Native Hawaiian, and 67% collected disaggregated data on Pacific Islander (3 subgroups) people. Collection of disaggregated AANHPI data in HHS-administered surveys increased from 2011 to 2021, but opportunities to expand collection and reporting remain. Strategies include outreach with community organizations, increased language assistance, and oversampling approaches. Increased availability and reporting of these data can inform health policies and mitigate disparities. (Am J Public Health. 2022;112(10):1429–1435. https://doi.org/10.2105/AJPH.2022.306969) [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Rhetoric and policies aimed at restricting immigration to the United States, such as those proposed during the Trump administration, may lead to reduced enrollment in Medicaid for children of immigrants, even those who were legally eligible. This study assessed how children's health insurance coverage changed before versus during the Trump administration by parental immigration status. METHODS: Using American Community Survey data, we compared changes in rates of uninsurance and Medicaid enrollment for children in the United States before (2015 to 2016) versus during (2017 to 2019) the Trump administration. Children were categorized by parental immigration status: citizen children with US-born parents, citizen children with naturalized parents, children from mixed-status families, or noncitizen children. RESULTS: The study population included 2 963787 children between 2015 and 2019, representing approximately 64million children annually. Throughout our study period, uninsurance rates for children from mixed-status families and noncitizen children were higher than citizen children with United States-born parents. Beginning in 2017, there were significant increases in uninsurance among children from mixed-status families (0.48 percentage points [PP], 95%confidence interval [CI]: 0.06 to 0.91) that increased to 1.48 PP (95%CI: 0.98 to 1.99) by 2019when compared with concurrent trends among citizen children with US-born parents. Changes were accompanied by significant decreases in Medicaid enrollment by 2019 (-0.89 PP, 95%CI: -1.62 to - 0.16). CONCLUSIONS: There were substantial disparities in uninsurance rates by parental immigration status. Compared with citizen children with US-born parents, uninsurance rates among children from mixed-status families significantly increased between 2017 and 2019, with the magnitude of disparity widening over time. [ABSTRACT FROM AUTHOR]

We demonstrate that the one-loop exact subleading soft graviton theorem automatically follows from conservation of the BMS charges, provided that the hard and soft fluxes separately represent the extended BMS algebra at null infinity. This confirms that superrotations are genuine symmetries of the gravitational S -matrix beyond the semiclassical regime. In contrast with a previous proposal, the celestial stress tensor accounting for the one-loop corrections follows from the gravitational phase space analysis and does not require the addition of divergent counterterms. Moreover, we show that the symplectic form on the radiative phase space factorises into hard and soft sectors, and that the resulting canonical generators precisely coincide with the correct BMS fluxes. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine changes in plan composition and enrollee experience associated with Medicaid expansion among Medicaid managed care organization (MCO) enrollees. STUDY DESIGN: Using 2012-2018 Adult Medicaid Consumer Assessment of Healthcare Providers and Systems surveys, we estimated changes in MCO enrollee characteristics and 4 outcomes: having access to needed care, having a personal doctor, having timely access to a checkup, and having timely access to specialty care. METHODS: We estimated multivariable linear probability models comparing pre- vs postexpansion changes in expansion vs nonexpansion states. The postexpansion period was modeled as an event-study regression to account for changes over time. The coefficient of interest was a Medicaid expansion--by--year term. RESULTS: Medicaid expansion was associated with statistically significant decreases in the proportion of female enrollees (-8.4 percentage points [PP]; P < .01) and increases in the proportion of enrollees who were aged 55 to 64 years (6.8 PP; P < .01) and were non-Hispanic White (4.4 PP; P < .01). Relative to enrollees in nonexpansion states, MCO enrollees in expansion states were significantly less likely to report access to a personal doctor (-1.6 PP; 95% CI, -3.0 to -0.1 PP) and less likely to report timely access to specialty care (-2.1 PP; 95% CI, -3.4 to -0.8 PP; P < .01) in the first year after expansion. Differences were not statistically significant by the second year post expansion. There were not significant changes in the other 2 outcomes. CONCLUSIONS: State policy makers may need to account for the role that Medicaid expansion may have in changing Medicaid MCO enrollee composition to prevent unfair penalization on performance metrics. [ABSTRACT FROM AUTHOR]

Introduction: Federally Qualified Health Centers serve 29.8 million low-income patients across the U.S., many of whom have unaddressed social risks. In 2019, for the first time, data on social risk screening capabilities were collected from every U.S. Federally Qualified Health Center. The objectives of this study were to describe the national rates of social risk screening capabilities across Federally Qualified Health Centers, identify organizational predictors of screening, and assess between-state heterogeneity.Methods: Using a 100% sample of U.S. Federally Qualified Health Centers (N=1,384, representing 29.8 million patients) from the 2019 Uniform Data System, the primary outcome was whether a Federally Qualified Health Center collected data on patients' social risk factors (yes/no). Summary statistics on the rates of social risk screening capabilities were generated in aggregate and by state. Linear probability models were then used to estimate the relationship between the probability of social risk screening and 7 key Federally Qualified Health Center characteristics (e.g., Federally Qualified Health Center size, Medicaid MCO contract, Medicaid accountable care organization presence). Data were analyzed in 2020‒2021.Results: Most (71%) Federally Qualified Health Centers collected social risk data, with a between-state variation. The most common screener was the Protocol for Responding to and Assessing Patients' Assets Risks and Experiences (43% of Federally Qualified Health Centers that screened), whereas 22% collected social risk data using a nonstandardized screener. After adjusting for other characteristics, Federally Qualified Health Centers with social risk screening capabilities served more total patients, were more likely to be located in a state with a Medicaid accountable care organization, and were less likely to have an MCO contract.Conclusions: There has been widespread adoption of social risk screening tools across U.S. Federally Qualified Health Centers, but between-state disparities exist. Targeting social risk screening resources to smaller Federally Qualified Health Centers may increase the adoption of screening tools. [ABSTRACT FROM AUTHOR]

This article discusses the rates of social risk factor screening among patients at Federally Qualified Health Centers (FQHCs) in the United States. FQHCs provide primary care services to low-income patients, and screening for social risk factors is important in identifying adverse social conditions that impact health. The study found that 62% of FQHCs collected social risk data using a standardized screener, and among those that screened, 25.5% of patients had documentation of being screened. However, there was wide variation in screening rates among FQHCs. The article emphasizes the need to optimize screening rates and connect patients with social resources, and suggests that training programs, technical assistance, and funding for community health workers may help improve screening and resource connection. [Extracted from the article]

The lack of biomarkers to inform antidepressant selection is a key challenge in personalized depression treatment. This work identifies candidate biomarkers by building deep learning predictors of individual treatment outcomes using reward processing measures from functional magnetic resonance imaging, clinical assessments, and demographics. Participants in the EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care) study (n = 222) underwent reward processing task-based functional magnetic resonance imaging at baseline and were randomized to 8 weeks of sertraline (n = 106) or placebo (n = 116). Subsequently, sertraline nonresponders (n = 37) switched to 8 weeks of bupropion. The change in Hamilton Depression Rating Scale was measured after treatment. Reward processing, clinical measurements, and demographics were used to train treatment-specific deep learning models. The predictive model for sertraline achieved R 2 of 48% (95% CI, 33%–61%; p < 10−3) in predicting the change in Hamilton Depression Rating Scale and number-needed-to-treat (NNT) of 4.86 participants in predicting response. The placebo model achieved R 2 of 28% (95% CI, 15%–42%; p < 10−3) and NNT of 2.95 in predicting response. The bupropion model achieved R 2 of 34% (95% CI, 10%–59%, p < 10−3) and NNT of 1.68 in predicting response. Brain regions where reward processing activity was predictive included the prefrontal cortex and cerebellar crus 1 for sertraline and the cingulate cortex, caudate, orbitofrontal cortex, and crus 1 for bupropion. These findings demonstrate the utility of reward processing measurements and deep learning to predict antidepressant outcomes and to form multimodal treatment biomarkers. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) is the fourth most common neurodevelopmental disorder, with a prevalence of 1 in 160 children. Accurate diagnosis relies on experts, but such individuals are scarce. This has led to increasing interest in the development of machine learning (ML) models that can integrate neuroimaging features from functional and structural MRI (fMRI and sMRI) to help reveal central nervous system alterations characteristic of ASD. We optimized and compared the performance of 12 of the most popular and powerful ML models. Each was separately trained using 15 different combinations of fMRI and sMRI features and optimized with an unbiased model search. Deep learning models predicted ASD with the highest diagnostic accuracy and generalized well to other MRI datasets. Our model achieves state-of-the-art 80% area under the ROC curve (AUROC) in diagnosis on test data from the IMPAC dataset; and 86% and 79% AUROC on the external ABIDE I and ABIDE II datasets (with further improvement to 93% and 90% after supervised domain adaptation). The highest performing models identified reproducible putative biomarkers for accurate ASD diagnosis in accord with known ASD markers as well as novel cerebellar biomarkers. Such reproducibility lends credence to their tremendous potential for defining and using a set of truly generalizable ASD biomarkers that will advance scientific understanding of neuronal changes in ASD. [ABSTRACT FROM AUTHOR]

Medicaid managed care enrollees who are members of racial and ethnic minority groups have historically reported worse care experiences than White enrollees. Few recent studies have identified disparities within and between Medicaid managed care plans. Using 2014-18 data on 242,274 nonelderly Medicaid managed care enrollees in thirty-seven states, we examined racial and ethnic disparities in four patient experience metrics. Compared with White enrollees, minority enrollees reported significantly worse care experiences. Overall adjusted disparities for Black enrollees ranged between 1.5 and 4.5 percentage points; 1.6-3.9 percentage points for Hispanic or Latino enrollees; and 9.0-17.4 percentage points for Asian American, Native Hawaiian, or other Pacific Islander enrollees. Disparities were largely attributable to worse experiences by race or ethnicity within the same plan. For all outcomes, disparities were smaller in plans with the highest percentages of Hispanic or Latino enrollees, and for some outcomes, there were smaller disparities in plans with the highest percentages of Asian American, Native Hawaiian, or other Pacific Islander enrollees. Interventions to mitigate racial and ethnic inequities in care experiences include collection of comprehensive race and ethnicity data, adoption of health equity performance metrics, plan-level enrollee engagement, and multisectoral initiatives to dismantle structural racism. [ABSTRACT FROM AUTHOR]

National estimates suggest that kidney failure incidence is declining in the US. However, whether this trend is evident in areas with socioeconomic disadvantage is unknown. We examined trends in kidney failure incidence by county-level poverty between 2000 and 2017 and divided the study period into period 1 (2000-05), period 2 (2006-11), and period 3 (2012-17). The magnitude of disparity in kidney failure incidence between high- and low-poverty counties increased from 42.8 more incident cases per million in high-poverty counties in period 1 to 100.1 more in period 3. Despite a national decline, kidney failure incidence increased in high-poverty counties, and disparities between high- and low-poverty counties widened from 2000 to 2017. Achieving the Department of Health and Human Services objective of reducing incident kidney failure cases by 25 percent by 2030 will require focused attention on preventing kidney failure in counties with higher poverty. [ABSTRACT FROM AUTHOR]

The generating functional of stress tensor correlation functions in two-dimensional conformal field theory is the nonlocal Polyakov action, or equivalently, the Liouville or Alekseev-Shatashvili action. I review its holographic derivation within the AdS3/CFT2 correspondence, both in metric and Chern-Simons formulations. I also provide a detailed comparison with the well-known Hamiltonian reduction of three-dimensional gravity to a flat Liouville theory, and conclude that the two results are unrelated. In particular, the flat Liouville action is still off-shell with respect to bulk equations of motion, and simply vanishes in case the latter are imposed. The present study also suggests an interesting re-interpretation of the computation of black hole spectral statistics recently performed by Cotler and Jensen as that of an explicit averaging of the partition function over the boundary source geometry, thereby providing potential justification for its agreement with the predictions of a random matrix ensemble. [ABSTRACT FROM AUTHOR]

Background: We investigate the nature of planning the canoeing of rapids and its reasoning processes, while at the same time advancing a syncretic approach to cognitive and situative theories of learning. Building upon the work of Lucy Suchman, we examine how canoers plan to run rapids and how plans serve as resources for action. Methods: In ethnographically-informed manner, we followed a team of canoers across various contexts of rapid scouting and running. By mounting video cameras on canoeing dyads' helmets, we captured the team's discursive construction of plans, how canoe partners took up the collective production of plans to elaborate their own plans, and how plans seemed to function as resources for canoeing action. Findings: Through the analysis of three episodes of rapid running, we articulate detailed descriptions of reasoning processes at the collective, canoeing dyad and individual levels, and draw relationships between them to explain observed canoeing performance in its full complexity. Contribution: We show that drawing on intersections, affinities, and complementarities between principles and theoretical constructs from both cognitive and situative theories of learning may achieve a more holistic, multi-level, and fine-grained description of knowing and learning as ongoing, at once collective and individual achievements. [ABSTRACT FROM AUTHOR]

Intra‐operative identification and preservation of parathyroid glands is an important but challenging aspect of thyroid surgery. Failure to do so may lead to transient or permanent hypocalcaemia, where the latter represents a serious complication causing life‐long morbidity. It would be beneficial, therefore, if a simple and reliable modality can be developed to assist in the identification of parathyroid glands intra‐operatively. The aim of this literature review is to provide an overview of intra‐operative modalities used to identify parathyroid glands with a particular focus on near‐infrared autofluorescence (NIRAF). Twenty‐seven studies were considered relevant in this literature review. Several modalities have been used to aid parathyroid gland identification, including Raman spectroscopy, indocyanine green angiography, and NIRAF. NIRAF technology allows parathyroid glands to spontaneously give off light (autofluorescence) when exposed to near‐infrared light at a wavelength of 785 nm, creating a contrast between tissues to allow intra‐operative differentiation. Studies utilising NIRAF technology were able to identify 76.3%–100% of parathyroid glands intra‐operatively. Furthermore, two randomised controlled trials comparing NIRAF and white light showed that the use of NIRAF was able to significantly increase the mean number of parathyroid glands detected and reduce the incidence of post‐operative hypocalcaemia. NIRAF is an emerging tool that has been shown to increase the number of intra‐operative parathyroid gland identification and reduce the rate of post‐operative hypocalcaemia in a safe and reproducible manner. Future trials are needed to evaluate the real‐life impact of NIRAF technology in outcomes of patients following thyroid surgery. [ABSTRACT FROM AUTHOR]

Infrared divergences in perturbative gravitational scattering amplitudes have been recently argued to be governed by the two-point function of the supertranslation Goldstone mode on the celestial sphere. We show that the form of this celestial two-point function simply derives from an effective action that also controls infrared divergences in the symplectic structure of General Relativity with asymptotically flat boundary conditions. This effective action finds its natural place in a path integral formulation of a celestial conformal field theory, as we illustrate by re-deriving the infrared soft factors in terms of celestial correlators. Our analysis relies on a well-posed action principle close to spatial infinity introduced by Compère and Dehouck. [ABSTRACT FROM AUTHOR]

Purpose: To assess the incidence, risk factors, and clinical outcomes associated with (Clostridioides difficile infection) CDI following urological surgery, which is the leading cause of nosocomial diarrhea and a growing public health burden. Methods: We queried the National Surgical Quality Improvement Program (NSQIP) to identify patients undergoing urological surgery in 2015–2016. We evaluated the 30-day incidence and factors associated with postoperative CDI and 30-day hospital readmission and length of stay as secondary outcomes. Among the subset of patients undergoing radical cystectomy with urinary diversion (surgery with highest CDI incidence) we used multivariable logistic regression analysis to evaluate independent clinical and demographic factors associated with postoperative CDI. Results: We identified 98,463 patients during the study period. The overall 30-day incidence of CDI was 0.31%, but varied considerably across surgery type. The risk of CDI was greatest following radical cystectomy with urinary diversion (2.72%) compared to all other urologic procedures (0.19%) and was associated with increased risk of hospital readmission (p < 0.0001), re-operation (p < 0.0001), and longer mean length of stay (p < 0.0001) in this cohort. Among patients undergoing radical cystectomy with urinary diversion, multivariable logistic regression revealed that preoperative renal failure (OR: 5.30, 95% CI 1.13–24.9, p = 0.035) and blood loss requiring transfusion (OR: 1.67, 95% CI 1.15–2.44, p = 0.0075) were independently associated with CDI. Conclusions: In a nationally representative cohort, the incidence of CDI was low but varied substantially across surgery types. CDI was most common following radical cystectomy and associated with potentially modifiable factors such as blood transfusion and significantly longer length of stay. [ABSTRACT FROM AUTHOR]

We study the origin of the recently proposed effective theory of stress tensor exchanges based on reparametrization modes, that has been used to efficiently compute Virasoro identity blocks at large central charge. We first provide a derivation of the nonlinear Alekseev-Shatashvili action governing these reparametrization modes, and argue that it should be interpreted as the generating functional of stress tensor correlations on manifolds related to the plane by conformal transformations. In addition, we demonstrate that the rules previously prescribed with the reparametrization formalism for computing Virasoro identity blocks naturally emerge when evaluating Feynman diagrams associated with stress tensor exchanges between pairs of external primary operators. We make a few comments on the connection of these results to gravitational theories and holography. [ABSTRACT FROM AUTHOR]

Introduction: Predictive biomarkers of Parkinson's Disease progression are needed to expedite neuroprotective treatment development and facilitate prognoses for patients. This work uses measures derived from resting-state functional magnetic resonance imaging, including regional homogeneity (ReHo) and fractional amplitude of low frequency fluctuations (fALFF), to predict an individual's current and future severity over up to 4 years and to elucidate the most prognostic brain regions.Methods: ReHo and fALFF are measured for 82 Parkinson's Disease subjects and used to train machine learning predictors of baseline clinical and future severity at 1 year, 2 years, and 4 years follow-up as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Predictive performance is measured with nested cross-validation, validated on an external dataset, and again validated through leave-one-site-out cross-validation. Important predictive features are identified.Results: The models explain up to 30.4% of the variance in current MDS-UPDRS scores, 55.8% of the variance in year 1 scores, and 47.1% of the variance in year 2 scores (p < 0.0001). For distinguishing high and low-severity individuals at each timepoint (MDS-UPDRS score above or below the median, respectively), the models achieve positive predictive values up to 79% and negative predictive values up to 80%. Higher ReHo and fALFF in several regions, including components of the default motor network, predicted lower severity across current and future timepoints.Conclusion: These results identify an accurate prognostic neuroimaging biomarker which may be used to better inform enrollment in trials of neuroprotective treatments and enable physicians to counsel their patients. [ABSTRACT FROM AUTHOR]

Introduction: Community health centers often screen for and address patients' unmet social needs. This study examines the degree to which community health center patients report receiving social needs assistance and compares measures of access and quality between patients who received assistance versus similar patients who did not.Methods: A nationally representative sample of 4,699 nonelderly adults receiving care at community health centers from the 2014-2015 Health Resources and Services Administration Health Center Patient Survey was used, representing 12.6 million patients. The exposure-having "received social needs assistance"-was based on whether a patient received any community health center assistance accessing social programs (e.g., applying for government benefits) or basic needs (e.g., obtaining transportation, housing, food). Using logistic regression models with inverse probability of treatment weights, outcomes for patients who received social needs assistance with similar patients who did not were compared. Study outcomes, reported as absolute adjusted differences, included reporting a community health center as a usual source of care, reporting the emergency department as a usual source of care, perceived quality of care, and willingness to recommend the community health center to others. Data were analyzed in 2020.Results: Of the sample, 36% reported receiving social needs assistance, where the most common form of assistance was applying for government benefits. Relative to similar patients who did not receive social needs assistance, patients receiving assistance were significantly more likely to report a community health center as their usual source of care (adjusted difference=7.2 percentage points, 95% CI=2.2, 12.1) and to report perceived quality of care as "the best" (adjusted difference=11.1, 95% CI=5.4, 16.9). They were significantly less likely to report the emergency department as their usual source of care (adjusted difference= -4.2, 95% CI= -7.0, -1.3).Conclusions: As community health centers and other providers consider providing social needs assistance to patients, these results suggest that doing so may be associated with improved access to and quality of care. [ABSTRACT FROM AUTHOR]

Introduction. Gallbladder agenesis (GA) is a rare congenital malformation, and majority are asymptomatic; however, symptomatic patients present with a clinical picture similar to biliary colic. Work up usually shows contracted gallbladder (GB) on ultrasound (US), and HIDA scan shows nonvisualization. Magnetic resonance cholangiopancreatography (MRCP) can be helpful in the diagnosis; however, the diagnosis without the latter can only be established intraoperatively. Management should be conservative treatment with antispasmodic drugs. Case Report. A 35-year-old female presented to the emergency department with nausea, vomiting, and worsening right upper quadrant (RUQ) abdominal pain. Vitals and laboratory values were unremarkable except for mild leukocytosis, and RUQ US reported "contracted GB, cholelithiasis, 4.2 mm wall thickness, and no ductal dilation." Surgical consultation was prompted by the diagnosis of acute cholecystitis. The patient was transferred to the operating room for laparoscopic cholecystectomy; however, no GB was found, which was confirmed by intraoperative indocyanine green cholangiography. The procedure was aborted. Postoperatively, CT scan showed absent GB. A HIDA scan showed nonvisualization of the GB after 4 hours. Gastroenterology consultation was suggested to assess for peptic ulcer disease, stricture, or other etiology for her presenting symptoms, and the upper endoscopy showed gastritis. Upper GI with small bowel follow-through study showed mild delayed gastric emptying and contrast in the colon in 45 minutes. Conclusion. When US imaging findings are equivocal for nonvisualization of GB in a patient with no known history of prior cholecystectomy, additional imaging is required considering the diagnosis of gallbladder agenesis. MRCP is the test of choice. Management is usually conservative with smooth muscle relaxants without the need for surgical operation. [ABSTRACT FROM AUTHOR]

Objective: To describe social needs among low‐income adults and estimate the relationship between level of unmet social needs and key indicators of health care access and quality. Data Source: National survey data from 12 states from the 2017 Behavioral Risk Factor Surveillance System, which added a "Social Determinants of Health" Module in 2017. Study Design: We examined differences in eight measures of health care access and quality (eg, check‐up in last 12 months, inability to see doctor due to cost, receipt of eye examination for diabetics) for low‐income adults with 0, 1, 2‐3, and 4+ unmet social needs based on 7 social needs measures. We used adjusted logistic regression models to estimate the association between level of unmet need and each outcome. Principal Findings: Most common unmet social needs included not having enough money for balanced meals (33 percent) or food (32 percent). After adjusting for observable characteristics, higher levels of unmet social need were associated with poorer access and quality. Compared to those with no reported unmet needs, having 4+ unmet needs was significantly associated with reduced probability of having a yearly check‐up (65 percent vs 78 percent, adjusted difference = −7.1 percentage points (PP)), receiving a flu vaccine (33 percent vs 42 percent, adjusted difference = −5.4 PP), having a personal doctor (74 percent vs 80 percent, adjusted difference = −3.1 PP), and having a foot (63 percent vs 80 percent, adjusted difference = −12.8 PP) or eye examination (61 percent vs 73 percent, adjusted difference = −12.6 PP) for diabetic patients, and increased probability of being unable to see a doctor due to cost (44 percent vs 9 percent, adjusted difference = 27.9 PP) and having diabetes affect the eyes (22 percent vs 19 percent, adjusted difference = 8.0 PP) at α = 0.05. Conclusions: Higher levels of unmet social needs were associated with poorer access to and quality of care among low‐income adults. Addressing social needs both inside and outside of health care settings may help mitigate these negative effects. Additional research on if and how to effectively do so is critical. [ABSTRACT FROM AUTHOR]

Background: Though Asian Americans made gains in coverage following the Affordable Care Act (ACA), substantial variations in access to care remain across different ethnic subgroups. Several states are considering adoption of policies to collect health data for Asian Americans that is disaggregated by ethnic subgroup, which may identify disparities in access to care.Objective: We examined coverage and access to care between non-Hispanic White and Asian American adults following the ACA in California. We first compared outcomes in non-Hispanic White adults with all Asian Americans in our sample, and then evaluated whether we detect disparities when data is disaggregated into five of the most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese).Design: Cross-sectional California Health Interview Survey data were collected between January 2014 and December 2016.Participants: Our sample included 19,201 non-Hispanic White and 3077 Asian American non-elderly adults age 18 to 64 living in California.Main Measures: Our outcomes were (1) being uninsured, (2) having a usual source of care, (3) delaying necessary medical care, and (4) delaying necessary prescription medications. Using multivariable logistic regression models, we examined our outcomes, adjusting for predisposing, enabling, need, and acculturation factors.Key Results: Compared with non-Hispanic Whites, some subgroups of Asian Americans reported significantly worse access to care: disaggregated, adjusted analyses revealed that Koreans were significantly less likely to report a usual source of care (adjusted odds ratio [AOR] = 0.31, p < 0.01) relative to non-Hispanic Whites. Chinese (AOR = 0.42, p < 0.01) and Vietnamese (AOR = 0.34, p < 0.01) adults were significantly less likely to delay necessary care.Conclusions: Disaggregated analyses identified differences in access to care for Asian American subgroups following the ACA. State policies to collect disaggregated health data for Asian Americans may reveal heterogeneity in experiences of care and inform specific policies to reduce disparities in access to care. [ABSTRACT FROM AUTHOR]

BACKGROUND: It remains controversial if Mohs surgery is superior to surgical excision in treating localized sebaceous carcinoma. OBJECTIVE: To compare Mohs surgery and surgical excision for treating patients with localized sebaceous carcinoma. MATERIALS AND METHODS: The US National Cancer Database was used to identify patients with histologically confirmed Stage 0 to 2 sebaceous carcinoma from 2004 to 2014. Clinicopathologic and socioeconomic factors were compared between treatment groups using the chi-square test. Overall survival (OS) was evaluated by log-rank test, multivariable Cox proportional hazard regression, and propensity score-matched analysis. Relative survival analyses compared with age- and sex-matched US population were performed. RESULTS : Of 1,265 patients, 234 received Mohs surgery and 1,031 received surgical excision. Mohs surgery had a higher rate of negative margin (p =.004). On multivariate Cox regression analysis, Mohs surgery was associated with longer OS than surgical excision (HR: 0.703, 95% CI: 0.496-0.995, p =.047). The survival benefit of Mohs surgery persisted on relative survival analysis and propensity score-matched analysis (p =.0385), after matching the 2 groups on patient and disease characteristics. CONCLUSION : Patients who received Mohs surgery had significantly longer OS when compared with those who received surgical excision. Prospective clinical trials comparing these treatment paradigms are warranted. [ABSTRACT FROM AUTHOR]

Background: In sudden and asymmetrical progressive sensorineural hearing loss (SNHL), magnetic resonance imaging (MRI) is required to evaluate retrocochlear pathology and, with recent advances in MRI techniques, inner ear pathology. Given the limited literature regarding inner ear pathology associated with SNHL, we aimed to assess the incidence of retrocochlear and inner ear pathology, and congenital malformation on MRI in sudden SNHL (SSNHL) and progressive SNHL. Methods: A total of 987 acoustic neuroma (AN) protocol MRI internal acoustic meatus studies performed at our institution to investigate SNHL between January 2013 and December 2015 inclusive were identified. Following categorization for indication of SSNHL versus progressive asymmetrical SNHL, MRIs with retrocochlear or inner ear abnormality, congenital malformation or other otology‐related abnormality were identified, and further data were collected for these patients including patient demographics, associated symptomatology, management and outcomes. Results: In SSNHL, aetiological abnormality on MRI was identified for 6.9% patients with AN present on 4% overall. 3.2% of MRIs for progressive asymmetrical SNHL identified a causative lesion with 2.3% of scans overall diagnosing AN. The incidence of congenital inner ear malformation on MRI in the setting of SSNHL and progressive asymmetrical SNHL are 1.7% and 0.6%, respectively. Conclusion: This is the first retrospective study of inner ear MRI abnormalities in both SSNHL and progressive asymmetrical SNHL in Australia and one of the largest cohorts published in the literature to date. MRI must be performed in the setting of SNHL to ensure aforementioned and rarer causative lesions are identified. [ABSTRACT FROM AUTHOR]

By about 2.0 billion years ago (Ga), there is evidence for a period best known for its extended, apparent geochemical stability expressed famously in the carbonate–carbon isotope data. Despite the first appearance and early innovation among eukaryotic organisms, this period is also known for a rarity of eukaryotic fossils and an absence of organic biomarker fingerprints for those organisms, suggesting low diversity and relatively small populations compared to the Neoproterozoic era. Nevertheless, the search for diagnostic biomarkers has not been performed with guidance from paleoenvironmental redox constrains from inorganic geochemistry that should reveal the facies that were most likely hospitable to these organisms. Siltstones and shales obtained from drill core of the ca. 1.3–1.4 Ga Roper Group from the McArthur Basin of northern Australia provide one of our best windows into the mid‐Proterozoic redox landscape. The group is well dated and minimally metamorphosed (of oil window maturity), and previous geochemical data suggest a relatively strong connection to the open ocean compared to other mid‐Proterozoic records. Here, we present one of the first integrated investigations of Mesoproterozoic biomarker records performed in parallel with established inorganic redox proxy indicators. Results reveal a temporally variable paleoredox structure through the Velkerri Formation as gauged from iron mineral speciation and trace‐metal geochemistry, vacillating between oxic and anoxic. Our combined lipid biomarker and inorganic geochemical records indicate at least episodic euxinic conditions sustained predominantly below the photic zone during the deposition of organic‐rich shales found in the middle Velkerri Formation. The most striking result is an absence of eukaryotic steranes (4‐desmethylsteranes) and only traces of gammacerane in some samples—despite our search across oxic, as well as anoxic, facies that should favor eukaryotic habitability and in low maturity rocks that allow the preservation of biomarker alkanes. The dearth of Mesoproterozoic eukaryotic sterane biomarkers, even within the more oxic facies, is somewhat surprising but suggests that controls such as the long‐term nutrient balance and other environmental factors may have throttled the abundances and diversity of early eukaryotic life relative to bacteria within marine microbial communities. Given that molecular clocks predict that sterol synthesis evolved early in eukaryotic history, and (bacterial) fossil steroids have been found previously in 1.64 Ga rocks, then a very low environmental abundance of eukaryotes relative to bacteria is our preferred explanation for the lack of regular steranes and only traces of gammacerane in a few samples. It is also possible that early eukaryotes adapted to Mesoproterozoic marine environments did not make abundant steroid lipids or tetrahymanol in their cell membranes. [ABSTRACT FROM AUTHOR]

Background: Patients treated for renal cell carcinoma (RCC) may be diagnosed with a metachronous, contralateral tumor. We evaluated the risks of contralateral tumor development using the Surveillance, Epidemiology, and End Results database.Methods: Among RCC patients, we identified those with a metachronous, contralateral RCC diagnosed ≥1 year after primary diagnosis. We performed a competing risks analysis to evaluate associations between clinicopathologic factors and metachronous, bilateral RCC. Cumulative incidence and standardized incidence ratios (SIRs) were calculated.Results: There were 80,403 cases of RCC identified, with a median follow-up of 8.3 years; of these, 1063 (1.3%) developed metachronous, contralateral RCC (median of 6 years after diagnosis). The cumulative incidence at 10, 20, and 30 years of follow-up was 1.5%, 3.1%, and 4.7%, respectively. An increased risk was observed among men (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.20-1.55), blacks (HR, 2.00; 95% CI, 1.71-2.33), and those with papillary histology (HR, 1.72; 95% CI, 1.41-2.10). Risk of metachronous disease decreased with increasing age at primary diagnosis (HR per 1-year increase, 0.97; 95% CI, 0.96-0.97). The SIRs were highest among those diagnosed at a younger age and remained elevated even after extended follow-up (>10 years).Conclusions: Our findings suggest that the cumulative incidence of metachronous, contralateral RCC may be higher than previously reported. Younger age, black race, papillary histology, and male sex increase the risk of metachronous, contralateral RCC development. The high SIRs seen in all demographic groups may support a rationale for lifelong surveillance, especially in high-risk subgroups with early disease onset. [ABSTRACT FROM AUTHOR]

Objective: To evaluate trends in the utilization of active surveillance (AS) in a nationally representative cancer database. AS has been increasingly recognized as an effective strategy for patients with small renal masses but little is known about national usage patterns.Methods: We identified patients with clinical T1a renal masses within the National Cancer Database in 2010 through 2014. Patients were classified according to initial management strategy received including AS, surgery, ablation, or other treatment. We characterized time trends in the use of AS vs definitive therapy and examined clinical and socio-demographic determinants of AS among patients with small renal masses using multivariable logistic regression models.Results: We identified 59,189 patients who satisfied the inclusion criteria. Of the total cohort, 1733 (2.9%) individuals received initial management with AS, while 57,456 (97.1%) received definitive treatment. Surveillance rates remained below 5% in all years. On multivariate analysis, patient age (OR: 1.08, 95% CI 1.08-1.09), smaller tumor size of <2 cm vs ≥2 cm (OR: 2.43, 95% CI: 2.20-2.7, P < .0001), management at an academic center vs community center (OR: 2.05, 95% CI: 1.83-2.29), and African American vs Caucasian race (OR: 1.56, 95% CI:1.35-1.80) were independently associated with use of AS as initial management.Conclusion: In a representative national cohort of patients with small renal masses, we observed clinical and facility-level differences in the utilization of active surveillance in patients with T1a renal masses. Further investigation is warranted to better understand the forces underlying initial management decisions for patients with small renal masses. [ABSTRACT FROM AUTHOR]

We present a unified treatment of the conserved asymptotic charges associated with any bosonic massless particle in any spacetime dimension. In particular we provide master formulae for the asymptotic charges and the central extensions in the corresponding charge algebras. These formulae can be explicitly evaluated for any given theory. For illustration we apply them to electromagnetism and gravity, thereby recovering earlier results. [ABSTRACT FROM AUTHOR]

Objective: To describe the national rate of social risk factor screening adoption among federally qualified health centers (FQHCs), examine organizational factors associated with social risk screening adoption, and identify barriers to utilizing a standardized screening tool in 2020. Data Source: 2020 Uniform Data System, a 100% sample of all US FQHCs (N = 1375). Study Design: We used multivariable linear probability models to assess the association between social risk screening adoption and key FQHC characteristics. We used descriptive statistics to describe variations in screening tool types and barriers to utilizing standardized tools. We thematically categorized open‐ended responses about tools and barriers. Data Collection: None. Principal Findings: In 2020, 68.9% of FQHCs screened patients for any social risk factors. Characteristics associated with a greater likelihood of screening adoption included having high proportions of patients best served in a language other than English (18.8 percentage point [PP] increase, 95% CI: 6.0, 31.6) and being larger in size (10.3 PP increase, 95% CI: 0.7, 20.0). Having higher proportions of uninsured patients (14.2 PP decrease, 95% CI: −25.5, −0.3) and participating in Medicaid‐managed care contracts (7.3 PP decrease, 95% CI: −14.2, −0.3) were associated with lower screening likelihood. Among screening FQHCs, the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) was the most common tool (47.1%). Among non‐screening FQHCs, common barriers to using a standardized tool included lack of staff training to discuss social issues (25.2%), inability to include screening in patient intake (21.7%), and lack of funding for addressing social needs (19.2%). Conclusions: Though most FQHCs screened for social risk factors in 2020, various barriers have prevented nearly 1 in 3 FQHCs from adopting a screening tool. Policies that provide FQHCs with resources to support training and workflow changes may increase screening uptake and facilitate engagement with other sectors. [ABSTRACT FROM AUTHOR]

Soft graviton theorems receive one-loop contributions that are logarithmic in the energy of the soft graviton, and which are closely related to tails of gravitational waveforms. We demonstrate that these logarithmic corrections are encoded in the Ward identity of superrotation symmetries, i.e. they follow from conservation of superrotation charge across spatial infinity i0. Our proof relies on a careful analysis of the radiative phase space admitting such gravitational tails, and the determination of the fluxes through null infinity I that act as canonical generators of superrotations on both gravitational and matter fields. All logarithmic terms are derived from the fluxes through correlations of the supertranslation Goldstone mode, provided care is taken in manipulating gravitationally interacting (i.e. dressed) rather than free fields. In cases where massive particles take part in the scattering process, logarithmic corrections also partly arise from the superrotation charge generator at timelike infinity i±. [ABSTRACT FROM AUTHOR]

Dear Editor, Mucoepidermoid carcinoma is typically a low-grade malignancy of the salivary glands. In addition, it is possible that cases of secondary metastasis of mucoepidermoid carcinomas could mistakenly be coded as primary tumors, and the workup and histopathologic examination to exclude another primary site or differentiate this tumor from adenosquamous carcinoma may have varied between patients. Mucoepidermoid carcinoma of the skin: a distinct entity from adenosquamous carcinoma: a case study with a review of the literature. [Extracted from the article]

The uninsurance rate among lesbian, gay, and bisexual (LGB) adults has dropped since the Affordable Care Act (ACA) and legalization of same-sex marriage. Less is known about whether disparities in access to care and health outcomes have narrowed in LGB adults compared to their straight peers in the post-ACA era. We used data from three waves of the Behavioral Risk Factor Surveillance System to examine access to a personal doctor, affordability of care, type of health insurance coverage, and self-reported health in LGB adults in the period January 2014-February 2017 in thirty-one states that implemented the system's sexual orientation module. Compared to straight adults, more LGB adults reported avoiding necessary care because of cost and worse self-reported health outcomes, even if they had health insurance. More LGB adults reported having individually purchased insurance, which suggests that the repeal of the ACA's individual mandate may create challenges in the affordability of necessary care. [ABSTRACT FROM AUTHOR]

Summary: Primary cutaneous CD30+ T cell lymphoproliferative disorders (PCLPD), the second most common type of primary cutaneous T cell lymphomas, accounts for approximately 25–30% of cutaneous T‐cell lymphoma cases. However, only small retrospective studies have been reported. We aimed to identify prognostic factors and evaluate the overall survival (OS) of patients with PCLPD stratified by ethnicity. We identified 1496 patients diagnosed with PCLPD between 2004 and 2014 in the US National Cancer Database. Chi‐square test and anova were used to evaluate differences in demographic and disease characteristics, socioeconomic factors and treatments received. OS was evaluated with the log‐rank test, Cox proportional hazard regression analysis, and propensity score matching. The study included 1267 Caucasians, 153 African Americans (AA), 43 Asians, and 33 of other/unknown ethnicity. Older age, higher Charlson‐Deyo score, higher clinical stage and receipt of chemotherapy were predictors of shorter OS. Primary disease site on a lower extremity was associated with shorter OS, while a head and neck location was associated with longer OS. AA patients had shorter OS when compared to Caucasian patients on multivariate analysis. This ethnic disparity persisted on propensity‐score matched analysis and after matching Caucasian and AA patients on demographic and disease characteristics, socioeconomic factors and treatments received, and age and gender‐matched relative survival analyses. [ABSTRACT FROM AUTHOR]

It remains controversial whether concurrent or subsequent chemoradiotherapy (CRT) provides additional survival benefits when compared to radiotherapy (RT) alone in localized extranodal natural killer/T-cell lymphoma (ENKTL), nasal type We identified 248 patients from the US National Cancer Data Base who were diagnosed with localized ENKTL from 2004-2014; 68.9% received CRT and 31.1% received RT alone. Over time, the use of CRT increased, while the use of RT alone decreased (p < .001). On multivariate analysis, CRT was associated with longer OS than RT alone (HR: 0.504; 95% CI: 0.338-0.751; p < .001), while uninsured status and African-American race were associated with shorter OS. The survival advantages of CRT over RT alone persisted on propensity score matching for the entire cohort (p = .0014) and in a subgroup analysis of elderly patients (p < .001). In conclusion, patients who received CRT had significantly longer OS than those who received RT alone. These results also apply to elderly patients. [ABSTRACT FROM AUTHOR]