Search

The difference in infant health outcomes by maternal opioid use disorder (OUD) status is understudied. We measured the association between maternal OUD during pregnancy and infant mortality and investigated whether this association differs by infant neonatal opioid withdrawal syndrome (NOWS) or maternal receipt of medication for OUD (MOUD) during pregnancy. We sampled 204,543 Medicaid-paid births from Wisconsin, United States (2010–2018). The primary exposure was any maternal OUD during pregnancy. We also stratified this exposure on NOWS diagnosis (no OUD; OUD without NOWS; OUD with NOWS) and on maternal MOUD receipt (no OUD; OUD without MOUD; OUD with <90 consecutive days of MOUD; OUD with 90+ consecutive days of MOUD). Our outcome was infant mortality (death at age <365 days). Demographic-adjusted logistic regressions measured associations with odds ratios (OR) and 95% confidence intervals (CI). Maternal OUD was associated with increased odds of infant mortality (OR 1.43; 95% CI 1.02–2.02). After excluding infants who died <5 days post-birth (i.e., before the clinical presentation of NOWS), regression estimates of infant mortality did not significantly differ by NOWS diagnosis. Likewise, regression estimates did not significantly differ by maternal MOUD receipt in the full sample. Maternal OUD is associated with an elevated risk of infant mortality without evidence of modification by NOWS nor by maternal MOUD treatment. Future research should investigate potential mechanisms linking maternal OUD, NOWS, MOUD treatment, and infant mortality to better inform clinical intervention. • We examined opioid use disorder (OUD) and infant mortality in a large birth cohort. • Maternal OUD in pregnancy may increase the odds of infant mortality. • Association did not significantly vary by neonatal opioid withdrawal syndrome. • Association did not significantly vary by medication for OUD receipt in pregnancy. [ABSTRACT FROM AUTHOR]

This paper examines the impacts of banking market structure and regulation on economic growth using new data on banking market concentration and manufacturing industry-level growth rates for U.S. states during 1899-1929--a period when the manufacturing sector was expanding rapidly and restrictive branching laws segmented the U.S. banking system geographically. Unlike studies of developing and developed countries today, we find that banking market concentration generally had a positive impact on manufacturing sector growth in the early twentieth century United States, with a somewhat stronger impact on industries with smaller establishments, lower rates of incorporation, and less reliance on bond markets (and, hence, relatively more reliance on banks). Because regulations affecting bank entry varied considerably across states and the industrial organization of the U.S. banking system differs markedly from those of other countries, we consider the impact of other aspects of banking market structure and policy on growth. Even after controlling for differences in the prevalence of branch banking, deposit insurance, and other aspects of policy and market structure, we find that market concentration boosted industrial growth. [ABSTRACT FROM AUTHOR]

A large body of social science literature has focused on the factors that influence sentencing outcomes within the federal court system. A neglected variable in this line of research is the citizenship status of the offender. Using the United States Sentencing Commission’s Monitoring of Federal Criminal Sentences data from 2006, the present study examines the effect of citizenship status on the likelihood of incarceration and the length of the prison sentence. This study extends previous research in three ways: first, by examining citizenship status using post-Booker data; second, exploring the differences between citizens, legal aliens, and illegal aliens rather than comparing all non-citizens to US citizens; and third, examining all offenses rather than only drug offenses. Most importantly, this study partitions the data by citizenship status to determine if the effects of race/ethnicity and other variables (e.g., type of offense and level of education) vary by citizenship status. The results demonstrate that both legal and illegal aliens have a higher probability of incarceration than similarly-situated US citizens, but that the sentences imposed on illegal aliens are shorter than those imposed on citizens. However, different results emerged when the data were partitioned by citizenship status. Judges imposed shorter prison sentences on Latino citizens, but longer prison sentences on Latino illegal aliens. These results are discussed in relation to theoretical explanations and policy implications. [Copyright &y& Elsevier]

Examines sex differences in spatial cognition, computational fluency and arithmetical reasoning in the United States. Comparison of sex difference in intelligence levels; Male advantage in arithmetic and spatial cognition; Association between arithmetical reasoning and intelligence quotient tests differences; Use of structural equation modeling.

Examines the effects of deposit insurance on bank behavior in Kansas during the 1920s. Kansas deposit insurance system; Decline in insurance credibility before 1926; Correlation between 1920s and 1990s deposit insurance systems.

Examines how the protein content in the diet of adult lekking Hawaiian Drosophila, influences their mating calls, mating success and male quality. Ways that these protein diets effect the male physical condition; Information on the attractiveness of females in the mating ritual; Results of the test showing that males fed with a higher protein content were in better physical condition; Statistical data provided to support findings.

Robotic weed control for vegetables is necessary to increase crop productivity, avoid intensive hand weeding as labour shortages in developed countries such as United States has led to a surge in food production costs. However, development of a reliable, intelligent robotic system for weed control in real-time for vegetables still remains a challenging task. The main issue arises while distinguishing crops from weeds in real-time. In this paper, a novel technique to crop signalling to distinguish crops from in-row weeds in complex natural scenarios, such as high weed densities commonly found on organic farms, in real-time using machine vision is presented. Crop signalling is a simple and low-cost technique in which a signalling compound is produced by or applied to the crop and where the signalling compound is machine readable and helps to create visual features that uniquely distinguish the crops from weeds. The crop and weed mapping algorithm presented here were specially designed and developed for a vision-based weeding robot equipped with a micro-jet herbicide-spraying system for weed control in a lettuce field. The proposed technique involves weed/crop mapping and decision making. Experimental results show that the crop detection accuracy was 99.75%, and 98.11% of sprayable weeds were detected. The proposed technique is highly accurate, reliable and more robust than other sensor-based techniques presented in the literature. Image 1 • A real-time in-row weed-crop detection and classification algorithm was proposed. • A novel crop signaling technique was introduced to distinguish crops from weeds. • It utilized computer vision to determine the spatial location of lettuce and weed. • The algorithm was designed to equipped with a micro-jet herbicide-spraying system. • The algorithm outperformed existing methods in terms classification accuracy. [ABSTRACT FROM AUTHOR]

Objective: The prevention research context includes current epidemic levels of hazards associated with extra-medical use of OxyContin® (to get high or otherwise outside prescribed boundaries) among teenagers and young adults, and a recent OxyContin® re-formulation with an intent to reduce these hazards, plus hope for possibly beneficial primary prevention impact. The aim is to create a benchmark of risk estimates for the years just prior to OxyContin® re-formulation in anticipation of potential public health benefit in future years, with a focus on teens and the youngest adults in the United States, and to compare two methods for estimating peak risk. Method: The data are from nationally representative probability sample surveys of 12–21year olds, yielding estimates for incidence of extra-medical OxyContin® use. Samples are of the non-institutionalized United States population, recruited and assessed in National Surveys on Drug Use and Health (NSDUH), each year from 2004 through 2008. In aggregate, the sample includes 135,552 young people who had not used OxyContin® extra-medically prior to their year of survey assessment. Results: The main outcome was the estimated population-level age-specific incidence of extra-medical OxyContin® use, 2004–2008. We found that during the 2004–2008 interval the estimated risk accelerated from age 12years, reached a peak value in mid-adolescence at roughly five newly incident users per 1000 persons per year (95% confidence intervals, 0.3%, 0.7%), and then declined. A meta-analysis approach to year-by-year data differentiated age patterns more clearly than a pooled estimation approach. Conclusion: Studying young people in the United States, we have discovered that the risk of starting to use OxyContin® extra-medically rises to a peak by mid-adolescence and then declines. From a methods standpoint, the meta-analysis serves well in this context; there is no advantage to pooling survey data across years. We also discovered that during any given year a pediatrician might rarely see even one patient who has just started to use OxyContin® to get high or for other extra-medical purposes. Implications for screening are discussed. [ABSTRACT FROM AUTHOR]

Traumatic injury is the leading cause of pediatric mortality and morbidity in the United States. Pediatric trauma survivors requiring inpatient rehabilitation (IPR) require coordinated, multispecialty follow-up. Knowledge of the nature and level of disability is necessary for planning this continued care that is specific to the needs of pediatric trauma patients. This study aims to describe the outcomes of pediatric and adolescent trauma patients using measures of functional progression. A retrospective review of trauma patients aged ≤18 y admitted to IPR between January 2018 and December 2020 at the only certified pediatric rehabilitation center in the region was performed. Ninety five children and adolescents were admitted to IPR after traumatic injury with diagnoses of multitrauma (MT, N = 18), traumatic brain injury (TBI, N = 59), and spinal cord injury (SCI, N = 18). School aged children returned to school at high rates for all injury types (MT: 86.7%, TBI: 97.4%, SCI: 93.8%, P = ns). All groups had similar hospital and rehabilitation length of stay, and most patients required a durable medical equipment at discharge (79%). Using pediatric functional independence measure scoring progression from admission to discharge from IPR, SCI patients made significant improvement in bladder function and the least improvement in stair function. Patients sustaining a TBI made significant improvement in memory and comprehension tasks. Pediatric and adolescent trauma patients admitted to IPR had a positive progression during their therapy but required variable ongoing care depending on the mechanism of injury. Excellent rates of returning to school were seen across the three injury types. [ABSTRACT FROM AUTHOR]

Abstract: Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a highly effective therapy for morbid obesity. As the most common postoperative complication, marginal ulcers (MU) present a significant disease burden. The etiology of marginal ulcers after gastric bypass has not been clearly defined. The purpose of this study was to identify independent risk factors for MU. Methods: We performed a retrospective study of a single surgeon''s experience performing LRYGB between July 2001 and January 2006 in a United States private practice and university hospital. We investigated patient factors and comorbidities associated with the development of marginal ulcers. The five most common comorbidities were hypertension, type 2 diabetes mellitus, gastroesophageal reflux disease, hyperlipidemia, and obstructive sleep apnea. We analyzed these factors using multivariate logistic regression adjusting for demographics, BMI, and all comorbidities. Results: In our 763 patients, 89% were female, 84.7% were African-American, and the mean BMI was 50.2 kg/m2 before surgery. Marginal ulcers occurred in 23 patients (3.01%) over a mean of 64 months. On χ2 analysis, hypertension, gastroesophageal reflux disease, hyperlipidemia, and sleep apnea were significantly correlated with MU. On multivariate analysis, the odds of marginal ulcer formation were 7.84 among hypertensive patients with a 95% confidence interval of 1.75–35.06 (P = 0.007). Hypertension was the only significant predictor of marginal ulcer disease. Conclusion: In our study, marginal ulcers occurred more frequently in patients with preoperative hypertension. At higher risk, these patients could be good candidates for extended acid suppression prophylaxis after LRYGB. [Copyright &y& Elsevier]

Abstract Background Nearly 1.5 million clinicians in the United States will be affected by Centers for Medicare and Medicaid Services' (CMS) new payment program, the Merit-based Incentive Program (MIPS), where clinicians will be penalized or rewarded based on the health care expenditures of their patients. We therefore examined expenditures for major cancer surgery to understand physician-specific variation in episode payments. Methods We used Surveillance, Epidemiology and End Results–Medicare data to identify patients aged 66–99 y who underwent a prostatectomy, nephrectomy, lung, or colorectal resection for cancer from 2008 to 2012. We calculated 90-d episode payments, attributed each episode to a physician, and evaluated physician-level payment variation. Next, we determined which component (index admission, readmission, physician services, postacute care, hospice) drove differences in payments. Finally, we evaluated payments by geographic region, number of comorbidities, and cancer stage. Results We identified 39,109 patients who underwent surgery by 1 of 7182 providers. There was wide variation in payments for each procedure (prostatectomy: $7046–$40,687; nephrectomy: $8855–$82,489; lung resection: $11,167–$223,467; colorectal resection: $9711–$199,480). The largest component difference in episode payments varied by condition: physician payments for prostatectomy (29%), postacute care for nephrectomy (38%) and colorectal resections (38%), and index hospital admission for lung resections (43%) but were fairly stable across region, comorbidity number, and cancer stage. Conclusions For patients undergoing major cancer surgery, 90-d episode payments vary widely across surgeons. The components driving such variation differ by condition but remain stable across region, number of comorbidities, and cancer stage. These data suggest that programs to reduce specific component payments may have advantages over those targeting individual physicians for decreasing health care expenditures. [ABSTRACT FROM AUTHOR]

Nepafenac ophthalmic suspensions, 0.1% (NEVANAC ® ) and 0.3% (ILEVRO™), are topical nonsteroidal anti-inflammatory drug (NSAID) products approved in the United States, Europe and various other countries to treat pain and inflammation associated with cataract surgery. NEVANAC is also approved in Europe for the reduction in the risk of postoperative macular edema (ME) associated with cataract surgery in diabetic patients. The efficacy against ME suggests that topical administration leads to distribution of nepafenac or its active metabolite amfenac to the posterior segment of the eye. This article evaluates the ocular distribution of nepafenac and amfenac and the extent of local delivery to the posterior segment of the eye, following topical ocular instillation in animal models. Nepafenac ophthalmic suspension was instilled unilaterally in New Zealand White rabbits as either a single dose (0.1%; one drop) or as multiple doses (0.3%, one drop, once-daily for 4 days, or 0.1% one drop, three-times daily for 3 days and one morning dose on day 4). Nepafenac (0.3%) was also instilled unilaterally in cynomolgus monkeys as multiple doses (one drop, three-times daily for 7 days). Nepafenac and amfenac concentrations in harvested ocular tissues were measured using high-performance liquid chromatography/mass spectrometry. Locally-distributed compound concentrations were determined as the difference in levels between dosed and undosed eyes. In single-dosed rabbit eyes, peak concentrations of locally-distributed nepafenac and amfenac showed a trend of sclera > choroid > retina. Nepafenac peak levels in sub-samples posterior to the eye equator and inclusive of the posterior pole (E-PP) were 55.1, 4.03 and 2.72 nM, respectively, at 0.25 or 0.50 h, with corresponding amfenac peak levels of 41.9, 3.10 and 0.705 nM at 1 or 4 h. By comparison, peak levels in sclera, choroid and retina sub-samples in a band between the ora serrata and the equator (OS-E) were 13- to 40-fold (nepafenac) or 11- to 23-fold (amfenac) higher, indicating an anterior-to-posterior directional concentration gradient. In multiple-dosed rabbit eyes, with 0.3% nepafenac instilled once-daily or 0.1% nepafenac instilled three-times daily, cumulative 24-h locally-distributed levels of nepafenac in E-PP retina were similar between these groups, whereas exposure to amfenac once-daily dosing nepafenac 0.3% was 51% of that achieved with three-times daily dosing of 0.1%. In single-dosed monkey eyes, concentration gradients showed similar directionality as observed in rabbit eyes. Peak concentrations of locally-distributed nepafenac were 1580, 386, 292 and 13.8 nM in E-PP sclera, choroid and retina, vitreous humor, respectively, at 1 or 2 h after drug instillation. Corresponding amfenac concentrations were 21.3, 11.8, 2.58 and 2.82 nM, observed 1 or 2 h post-instillation. The data indicate that topically administered nepafenac and its metabolite amfenac reach pharmacologically relevant concentrations in the posterior eye segment (choroid and retina) via local distribution, following an anterior-to-posterior concentration gradient. The proposed pathway involves a choroidal/suprachoroidal or periocular route, along with an inward movement of drug through the sclera, choroid and retina, with negligible vitreal compartment involvement. Sustained high nepafenac concentrations in posterior segment tissues may be a reservoir for hydrolysis to amfenac. [ABSTRACT FROM AUTHOR]

Abstract: Background: Carotid endarterectomy (CEA) has been performed since the 1950s and remains one of the most common surgical procedures in the United States. The procedure is performed by cardiothoracic, general, neurologic, and vascular surgeons. This study uses data from the National Surgical Quality Improvement Program (NSQIP) to examine the outcomes after CEA when performed by general or vascular surgeons. Materials and methods: Data included 34,493 CEAs from years 2005 to 2010 recorded in the NSQIP database. Primary outcomes measured were length of stay, 30-d mortality, surgical site infection, cerebrovascular accident, myocardial infarction, and blood transfusion requirement. Secondary outcomes measured were the remaining intraoperative outcomes from the NSQIP database. Results: After controlling for patient and surgical characteristics, patients treated by general surgeons did not have a significantly different LOS or 30-d mortality than those treated by vascular surgeons. Patients of general surgeons had nearly twice the risk of acquiring a surgical site infection (odds ratio [OR] = 1.94; P = 0.012), >1.5 times the risk of cerebrovascular accident (OR = 1.56; P = 0.008), and >1.8 times the risk of blood transfusion (OR = 1.85; P = 0.017) than those of vascular surgeons. Patients of general surgeons had less than half the risk of having a myocardial infarction (OR = 0.34; P = 0.031) than those of vascular surgeons. Conclusions: Surgical specialty is associated with a wide range of postoperative outcomes after CEA. Additional research is needed to explore practice and cultural differences across surgical specialty that may lead to outcome differences. [Copyright &y& Elsevier]

Abstract: Background: Blacks, Hispanics, and women are underrepresented in academic medicine. This study sought to identify recent trends in the academic appointments of underrepresented groups at all levels of academic medicine. Methods: This was a retrospective cross-sectional analysis of the Association of American Medical Colleges'' data on faculty at U.S. medical schools from 1997 to 2008. The distribution across race and gender at different academic ranks (instructor, assistant professor, associate professor, and full professor) and the leadership positions of chairperson and dean were calculated for each year of the study. Results: Averaged over the 12-y study period, whites accounted for 84.76% of professors, 88.26% of chairpersons, and 91.28% of deans. Asians represented 6.66% of professors, 3.52% of chairpersons, and 0% of deans. Blacks represented 1.25% of professors, 2.69% of chairpersons, and 4.94% of deans. Hispanics represented 2.76% of professors, 3.37% of chairpersons, and 2.91% of deans. Women represented 14.7% of professors, 9.2% of chairpersons, and 9.3% of deans. Overall, there was a net positive increase in the percentage of minority academic physicians in this study period, but at the current rate, it would take nearly 1000y for the proportion of black physicians to catch up to the percentage of African Americans in the general population. Additionally, year-by-year analysis demonstrates that there was a reduction in the percentage of each minority group for the last 2y of this study, in 2007 and 2008. Conclusions: Minorities, including Asian Americans, and women remain grossly underrepresented in academic medicine. Blacks have shown the least progress during this 12-y period. The disparity is greatest at the highest levels (professor, chairperson, and dean) of our field. We must redouble our efforts to recruit, retain, and advance minorities in academic medicine. [Copyright &y& Elsevier]

Abstract: The EPA reference dose for methylmercury (MeHg) was established using data from populations with greater exposures than those typical of the US. Few data are available on potential adverse health effects at lower levels. We examined relationships between hair mercury (Hg) levels and neuropsychological outcomes in a population of US children. This study included data from 355 children ages 6–10 enrolled in the New England Children''s Amalgam Trial. Data on total hair Hg levels, sociodemographic information and neuropsychological function were collected. We evaluated associations between hair Hg and neuropsychological test scores with linear regression methods and used generalized additive models to determine the shape of associations that departed from linearity. Models controlled for relevant covariates, including the potential beneficial effects of consuming fish. In adjusted models, we observed no significant linear relationships between hair Hg level and any test score. Significant departures from linearity were identified for WIAT Math Reasoning and WRAMVA Visual-Motor Composite scores. The association was positive for hair Hg levels below 0.5μg/g and negative for levels between 0.5 and 1.0μg/g. Overall, test scores of children with hair Hg levels ⩾1.0μg/g appeared to be lower than those of children with levels <1.0μg/g, but few children had levels in this upper range and these differences did not reach statistical significance. Hair Hg levels below 1.0μg/g in US school-age children were not adversely related to neuropsychological function. [Copyright &y& Elsevier]

Abstract: We report on spectroscopic observations of periodic Comet 9P/Tempel 1 by the Alice ultraviolet spectrograph on the Rosetta spacecraft in conjunction with NASA''s Deep Impact mission. Our objectives were to measure an increase in atomic and molecular emissions produced by the excavation of volatile sub-surface material. We unambiguously detected atomic oxygen emission from the quiescent coma but no enhancement at the 10% (1-σ) level following the impact. We derive a quiescent H2O production rate of with an estimated uncertainty of ∼30%. Our upper limits to the volatiles produced by the impact are consistent with other estimates. [Copyright &y& Elsevier]