Transcranial focused ultrasound-induced blood‒brain barrier opening in mice without shaving hairs
(2023) Scientific Reports, 13 (1), art. no. 13500, .
Xu, L.a , Gong, Y.a , Chien, C.-Y.a , Leuthardt, E.a b c , Chen, H.a b
a Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO 63130, United States
b Department of Neurosurgery, Washington University School of Medicine, Saint Louis, MO 63110, United States
c Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, Saint Louis, MO 63110, United States
Abstract
Acoustic coupling through hairs remains a challenge to performing transcranial-focused ultrasound procedures. Here, we demonstrated that this challenge could be addressed by using oil as the coupling medium, leveraging oil’s high affinity to hairs due to their inherent hydrophobicity. We compared focused ultrasound-induced blood–brain barrier opening (FUS-BBBO) outcomes in mice under three coupling conditions: oil with hairs (“oil + hairs”), ultrasound gel with hair shaving (“ultrasound gel + no hair”), and ultrasound gel with hairs (“ultrasound gel + hairs”). The quality of the coupling was evaluated by T 2 -weighted magnetic resonance imaging (MRI) and passive cavitation detection (PCD). The outcome of FUS-BBBO was assessed by MRI contrast agent extravasation using in vivo T 1 -weighted contrast-enhanced MRI. It was also evaluated by ex vivo fluorescence imaging of the mouse brain after intravenous injection of a model drug, Evans blue. The results showed that “oil + hairs” consistently achieved high-quality acoustic coupling without trapping air bubbles. The FUS-BBBO outcome was not significantly different between the “oil + hairs” and the “ultrasound gel + no hair” groups. These two groups had significantly higher levels of BBB opening than the “ultrasound gel + hairs” group. This study demonstrated that oil could be a coupling medium for transcranial FUS procedures without shaving hairs. © 2023, Springer Nature Limited.
Funding details
National Institutes of HealthNIHR01CA276174, R01EB027223, R01EB030102, R01MH116981, R01NS128461
Office of Extramural Research, National Institutes of HealthOER
Office of Research Infrastructure Programs, National Institutes of HealthORIP, NIH, NIH-ORIP, ORIP
Document Type: Article
Publication Stage: Final
Source: Scopus
Sickle Cell Disease Treatment with Arginine Therapy (STArT): study protocol for a phase 3 randomized controlled trial
(2023) Trials, 24 (1), art. no. 538, .
Rees, C.A.a b , Brousseau, D.C.c , Cohen, D.M.d , Villella, A.d , Dampier, C.a b , Brown, K.e , Campbell, A.e , Chumpitazi, C.E.f , Airewele, G.f , Chang, T.g , Denton, C.g , Ellison, A.h , Thompson, A.h , Ahmad, F.i , Bakshi, N.j k , Coleman, K.D.l , Leibovich, S.m , Leake, D.b , Hatabah, D.a , Wilkinson, H.b , Robinson, M.n , Casper, T.C.n , Vichinsky, E.o p , Morris, C.R.a b
a Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA W45830322, United States
b Children’s Healthcare of Atlanta, Atlanta, GA, United States
c Department of Pediatrics, Nemours Children’s Health Delaware and the Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, United States
d Nationwide Children’s Hospital, Columbus, OH, United States
e Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
f Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, United States
g Children’s Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
h Children’s Hospital of Philadelphia, Philadelphia, PA, United States
i Washington University in St. Louis, St. Louis, MO, United States
j Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
k Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, United States
l Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, WI, United States
m University of California, San Francisco, CA, United States
n University of Utah School of Medicine, Salt Lake City, UT, United States
o Center for Maternal-Fetal Precision Medicine, University of California, San Francisco, CA, United States
p Department of Pediatrics, UCSF-Benioff Children’s Hospital-Oakland, Oakland, CA, United States
Abstract
Background: Despite substantial illness burden and healthcare utilization conferred by pain from vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD), disease-modifying therapies to effectively treat SCD-VOE are lacking. The aim of the Sickle Cell Disease Treatment with Arginine Therapy (STArT) Trial is to provide definitive evidence regarding the efficacy of intravenous arginine as a treatment for acute SCD-VOE among children, adolescents, and young adults. Methods: STArT is a double-blind, placebo-controlled, randomized, phase 3, multicenter trial of intravenous arginine therapy in 360 children, adolescents, and young adults who present with SCD-VOE. The STArT Trial is being conducted at 10 sites in the USA through the Pediatric Emergency Care Applied Research Network (PECARN). Enrollment began in 2021 and will continue for 5 years. Within 12 h of receiving their first dose of intravenous opioids, enrolled participants are randomized 1:1 to receive either (1) a one-time loading dose of L-arginine (200 mg/kg with a maximum of 20 g) administered intravenously followed by a standard dose of 100 mg/kg (maximum 10 g) three times a day or (2) a one-time placebo loading dose of normal saline followed by normal saline three times per day at equivalent volumes and duration as the study drug. Participants, research staff, and investigators are blinded to the participant’s randomization. All clinical care is provided in accordance with the institution-specific standard of care for SCD-VOE based on the 2014 National Heart, Lung, and Blood Institute guidelines. The primary outcome is time to SCD-VOE pain crisis resolution, defined as the time (in hours) from study drug delivery to the last dose of parenteral opioid delivery. Secondary outcomes include total parental opioid use and patient-reported outcomes. In addition, the trial will characterize alterations in the arginine metabolome and mitochondrial function in children with SCD-VOE. Discussion: Building on the foundation of established relationships between emergency medicine providers and hematologists in a multicenter research network to ensure adequate participant accrual, the STArT Trial will provide definitive information about the efficacy of intravenous arginine for the treatment of SCD-VOE for children. Trial registration: The STArT Trial was registered in ClinicalTrials.gov on April 9, 2021, and enrollment began on June 21, 2021 (NCT04839354). © 2023, BioMed Central Ltd., part of Springer Nature.
Author Keywords
Arginine; Randomized controlled trial; Sickle cell disease; Vaso-occlusive pain
Funding details
1K23HL140142, 1K23HL140142-03S1
National Institutes of HealthNIH
U.S. Department of Health and Human ServicesHHS
National Heart, Lung, and Blood InstituteNHLBI5UH3HL148560
Health Resources and Services AdministrationHRSA
Doris Duke Charitable FoundationDDCF
Maternal and Child Health BureauMCHB
National Center for Complementary and Integrative HealthNCCIHK24AT009893
Georgia Clinical and Translational Science AllianceGaCTSAUL1-TR002378
Document Type: Article
Publication Stage: Final
Source: Scopus
Reliability of diurnal salivary cortisol metrics: A meta-analysis and investigation in two independent samples
(2023) Comprehensive Psychoneuroendocrinology, 16, art. no. 100191, .
Norton, S.A.a , Baranger, D.A.a , Young, E.S.b , Voss, M.a , Hansen, I.a , Bondy, E.a , Rodrigues, M.a , Paul, S.E.a , Edershile, E.c , Hill, P.L.a , Oltmanns, T.F.a , Simpson, J.c , Bogdan, R.a
a Washington University in St. Louis, Department of Psychological & Brain Sciences, United States
b Utrecht University, Department of Psychology, Netherlands
c University of Minnesota, Department of Psychology, United States
Abstract
Stress-induced dysregulation of diurnal cortisol is a cornerstone of stress-disease theories; however, observed associations between cortisol, stress, and health have been inconsistent. The reliability of diurnal cortisol features may contribute to these equivocal findings. Our meta-analysis (5 diurnal features from 11 studies; total participant n = 3307) and investigation (15 diurnal cortisol features) in 2 independent studies (St. Louis Personality and Aging Network [SPAN] Study, n = 147, ages 61–73; Minnesota Longitudinal Study of Risk and Adaptation [MLSRA] Study, n = 90, age 37) revealed large variability in the day-to-day test-retest reliability of diurnal features derived from salivary cortisol data (i.e., ICC = 0.00–0.75). Collectively, these data indicate that some commonly used diurnal cortisol features have poor reliability that is insufficient for individual differences research (e.g., cortisol awakening response) while others (e.g., area under the curve with respect to ground) have fair-to-good reliability that could support reliable identification of associations in well-powered studies. © 2023 The Authors
Author Keywords
Cortisol; Reliability; Stress; Variability
Document Type: Article
Publication Stage: Final
Source: Scopus
Asymmetric Hearing Loss in Adult Cochlear Implant Recipients: Results and Recommendations From a Multisite Prospective Clinical Trial
(2023) Ear and Hearing, 44 (5), pp. 1140-1156.
Firszt, J.B.a , Holden, L.K.a , Dwyer, N.Y.a , Reeder, R.M.a , Strube, M.J.b , Asymmetric Hearing Study Teamc
a Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States
b Department of Psychological and Brain Science, Washington University, St. Louis, MO, United States
Abstract
OBJECTIVE: A multisite clinical trial was conducted to obtain cochlear implant (CI) efficacy data in adults with asymmetric hearing loss (AHL) and establish an evidence-based framework for clinical decision-making regarding CI candidacy, counseling, and assessment tools. Study hypotheses were threefold: (1) 6-month postimplant performance in the poor ear (PE) with a CI will be significantly better than preimplant performance with a hearing aid (HA), (2) 6-month postimplant performance with a CI and HA (bimodal) will be significantly better than preimplant performance with bilateral HAs (Bil HAs), and (3) 6-month postimplant bimodal performance will be significantly better than aided, better ear (BE) performance. DESIGN: Forty adults with AHL from four, metropolitan CI centers participated. Hearing criteria for the ear to be implanted included (1) pure-tone average (PTA, 0.5, 1, 2 kHz) of >70 dB HL, (2) aided, monosyllabic word score of ≤30%, (3) duration of severe-to-profound hearing loss of ≥6 months, and (4) onset of hearing loss ≥6 years of age. Hearing criteria for the BE included (1) PTA (0.5, 1, 2, 4 kHz) of 40 to 70 dB HL, (2) currently using a HA, (3) aided, word score of >40%, and (4) stable hearing for the previous 1-year period. Speech perception and localization measures, in quiet and in noise, were administered preimplant and at 3-, 6-, 9-, and 12-months postimplant. Preimplant testing was performed in three listening conditions, PE HA, BE HA, and Bil HAs. Postimplant testing was performed in three conditions, CI, BE HA, and bimodal. Outcome factors included age at implantation and length of deafness (LOD) in the PE. RESULTS: A hierarchical nonlinear analysis predicted significant improvement in the PE by 3 months postimplant versus preimplant for audibility and speech perception with a plateau in performance at approximately 6 months. The model predicted significant improvement in postimplant, bimodal outcomes versus preimplant outcomes (Bil HAs) for all speech perception measures by 3 months. Both age and LOD were predicted to moderate some CI and bimodal outcomes. In contrast with speech perception, localization in quiet and noise was not predicted to improve by 6 months when comparing Bil HAs (preimplant) to bimodal (postimplant) outcomes. However, when participants’ preimplant everyday listening condition (BE HA or Bil HAs) was compared with bimodal performance, the model predicted significant improvement by 3 months for localization in quiet and noise. Lastly, BE HA results were stable over time; a generalized linear model analysis revealed bimodal performance was significantly better than performance with a BE HA at all postimplant intervals for most speech perception measures and localization. CONCLUSIONS: Results revealed significant CI and bimodal benefit for AHL participants by 3-months postimplant, with a plateau in CI and bimodal performance at approximately 6-months postimplant. Results can be used to inform AHL CI candidates and to monitor postimplant performance. On the basis of this and other AHL research, clinicians should consider a CI for individuals with AHL if the PE has a PTA (0.5, 1, 2 kHz) >70 dB HL and a Consonant-Vowel Nucleus-Consonant word score ≤40%. LOD >10 years should not be a contraindication. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Document Type: Article
Publication Stage: Final
Source: Scopus
Differential processing of risk and reward in delinquent and non-delinquent youth
(2023) Social Cognitive and Affective Neuroscience, 18 (1), .
Duell, N.a b , Perino, M.T.c , McCormick, E.M.d , Telzer, E.H.a
a Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel HillNC 27514, United States
b Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel HillNC 27514, United States
c Department of Psychiatry, Washington University School of Medicine in St. LouisMO 63110, United States
d Institute of Psychology, Leiden University, Leiden, 2333 AK, Netherlands
Abstract
The present study examined the behavioral and neural differences in risky decision-making between delinquent (n = 23) and non-delinquent (n = 27) youth ages 13-17 years (M = 16, SD = 0.97) in relation to reward processing. While undergoing functional neuroimaging, participants completed an experimental risk task wherein they received feedback about the riskiness of their behavior in the form of facial expressions that morphed from happy to angry. Behavioral results indicated that delinquent youth took fewer risks and earned fewer rewards on the task than non-delinquent youth. Results from whole-brain analyses indicated no group differences in sensitivity to punishments (i.e. angry faces), but instead showed that delinquent youth evinced greater neural tracking of reward outcomes (i.e. cash-ins) in regions including the ventral striatum and inferior frontal gyrus. While behavioral results show that delinquent youth were more risk-averse, the neural results indicated that delinquent youth were also more reward-driven, potentially suggesting a preference for immediate rewards. Results offer important insights into differential decision-making processes between delinquent and non-delinquent youth. © The Author(s) 2023. Published by Oxford University Press.
Author Keywords
adolescents; delinquency; fMRI; risk-taking; ventral striatum
Document Type: Article
Publication Stage: Final
Source: Scopus
Human microbiome variation associated with race and ethnicity emerges as early as 3 months of age
(2023) PLoS Biology, 21 (8), p. e3002230.
Mallott, E.K.a b c , Sitarik, A.R.d , Leve, L.D.e , Cioffi, C.e , Camargo, C.A., Jrf , Hasegawa, K.f , Bordenstein, S.R.a b g h i j k
a Vanderbilt Microbiome Innovation Center, Vanderbilt University, Nashville, TN, United States
b Department of Biological Sciences, Vanderbilt University, Nashville, TN, United States
c Department of Biology, Washington University in St. Louis, St. Louis, MO, United States
d Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
e Prevention Science Institute, University of Oregon, Eugene, OR, United States
f Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
g Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
h Vanderbilt Institute for Infection, Immunology, Inflammation, Vanderbilt University Medical Center, Nashville, TN, United States
i Department of Pathology, Microbiology, Immunology, Vanderbilt University Medical Center, School of Medicine, Nashville, TN, United States
j Departments of Biology and Entomology, Pennsylvania State University, University ParkPA, United States
k One Health Microbiome Center, Huck Institutes of the Life Sciences, Pennsylvania State University, University ParkPA, United States
Abstract
Human microbiome variation is linked to the incidence, prevalence, and mortality of many diseases and associates with race and ethnicity in the United States. However, the age at which microbiome variability emerges between these groups remains a central gap in knowledge. Here, we identify that gut microbiome variation associated with race and ethnicity arises after 3 months of age and persists through childhood. One-third of the bacterial taxa that vary across caregiver-identified racial categories in children are taxa reported to also vary between adults. Machine learning modeling of childhood microbiomes from 8 cohort studies (2,756 samples from 729 children) distinguishes racial and ethnic categories with 87% accuracy. Importantly, predictive genera are also among the top 30 most important taxa when childhood microbiomes are used to predict adult self-identified race and ethnicity. Our results highlight a critical developmental window at or shortly after 3 months of age when social and environmental factors drive race and ethnicity-associated microbiome variation and may contribute to adult health and health disparities. Copyright: © 2023 Mallott et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Document Type: Article
Publication Stage: Final
Source: Scopus
Characterization of High-Gamma Activity in Electrocorticographic signals
(2023) Frontiers in Neuroscience, 17, art. no. 1206120, .
Gruenwald, J.a b , Sieghartsleitner, S.a b , Kapeller, C.a , Scharinger, J.b , Kamada, K.c d , Brunner, P.e f , Guger, C.a
a g.tec medical engineering GmbH, Schiedlberg, Austria
b Institute of Computational Perception, Johannes Kepler University, Linz, Austria
c Department for Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
d Hokashin Group Megumino Hospital, Sapporo, Japan
e National Center for Adaptive Neurotechnologies, Albany, NY, United States
f Department of Neurosurgery, Washington University School of Medicine, St. Louis, MI, United States
Abstract
Introduction: Electrocorticographic (ECoG) high-gamma activity (HGA) is a widely recognized and robust neural correlate of cognition and behavior. However, fundamental signal properties of HGA, such as the high-gamma frequency band or temporal dynamics of HGA, have never been systematically characterized. As a result, HGA estimators are often poorly adjusted, such that they miss valuable physiological information. Methods: To address these issues, we conducted a thorough qualitative and quantitative characterization of HGA in ECoG signals. Our study is based on ECoG signals recorded from 18 epilepsy patients while performing motor control, listening, and visual perception tasks. In this study, we first categorize HGA into HGA types based on the cognitive/behavioral task. For each HGA type, we then systematically quantify three fundamental signal properties of HGA: the high-gamma frequency band, the HGA bandwidth, and the temporal dynamics of HGA. Results: The high-gamma frequency band strongly varies across subjects and across cognitive/behavioral tasks. In addition, HGA time courses have lowpass character, with transients limited to 10 Hz. The task-related rise time and duration of these HGA time courses depend on the individual subject and cognitive/behavioral task. Task-related HGA amplitudes are comparable across the investigated tasks. Discussion: This study is of high practical relevance because it provides a systematic basis for optimizing experiment design, ECoG acquisition and processing, and HGA estimation. Our results reveal previously unknown characteristics of HGA, the physiological principles of which need to be investigated in further studies. Copyright © 2023 Gruenwald, Sieghartsleitner, Kapeller, Scharinger, Kamada, Brunner and Guger.
Author Keywords
biosignal processing; brain-computer interface; electrocorticography; high-gamma activity; high-gamma frequency band
Funding details
257695
National Institutes of HealthNIHP41-EB018783, P50-MH109429, R01-EB026439, U01-NS108916, U01-NS128612, U24-NS109103
Army Research OfficeAROW911NF-14-1-0440
Document Type: Article
Publication Stage: Final
Source: Scopus
Finding new and better treatments for psychiatric disorders
(2023) Neuropsychopharmacology, .
Paul, S.M.a , Potter, W.Z.b
a Karuna Therapeutics, Washington University School of Medicine, St. Louis, MO, United States
b Independent Consultant, Philadelphia, PA, United States
Abstract
In contrast to most fields of medicine, progress to discover and develop new and improved psychiatric drugs has been slow and disappointing. The vast majority of currently prescribed drugs to treat schizophrenia, mood and anxiety disorders are arguably no more effective than the first generation of psychiatric drugs introduced well over 50 years ago. With only a few exceptions current psychiatric drugs work via the same fundamental mechanisms of action as first-generation agents. Here we describe the reasons for this slow progress and outline a number of areas of research that involve a greater reliance on experimental therapeutics utilizing recent advances in neuroscience to better understand disease biology. We exemplify the potential impact of these areas of research focus with several recent examples of novel agents that have emerged and which support our optimism that newer, more effective and better tolerated agents, are on the horizon. Together with existing drugs these newer agents and novel mechanisms could offer markedly improved functional outcomes for the millions of people still disabled by psychiatric disorders. © 2023, The Author(s).
Document Type: Article
Publication Stage: Article in Press
Source: Scopus
Assessment of proxy-reported responses as predictors of motor and sensory peripheral neuropathy in children with B-lymphoblastic leukemia
(2023) Pediatric Blood and Cancer, .
Rodwin, R.L.a b , DelRocco, N.J.c , Hibbitts, E.c , Devidas, M.d , Whitley, M.K.a , Mohrmann, C.E.e f , Schore, R.J.g h , Raetz, E.i , Winick, N.J.j , Hunger, S.P.k , Loh, M.L.l , Hockenberry, M.J.m n , Ma, X.b o p , Angiolillo, A.L.g h q , Ness, K.K.r , Kairalla, J.A.c , Kadan-Lottick, N.S.s
a Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
b Yale Cancer Center, New Haven, CT, United States
c Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, United States
d Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
e Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, United States
f Goldfarb School of Nursing, St. Louis, MO, United States
g Center of Cancer and Blood Disorders, Children’s National Health System, Washington, DC, United States
h George Washington University School of Medicine and Health Sciences, Washington, DC, United States
i Department of Pediatrics, NYU Langone Health, New York, NY, United States
j Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
k Department of Pediatrics and the Center for Childhood Cancer Research, Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
l Division of Pediatric Hematology, Oncology, Bone Marrow Transplant and Cellular Therapy, Seattle Children’s Hospital and the Ben Towne Center for Childhood Cancer Research, University of Washington, Seattle, WA, United States
m Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
n School of Nursing, Duke University, Durham, NC, United States
o Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
p Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, United States
q Servier Pharmaceuticals, Boston, MA, United States
r Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
s Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN), a common condition in children with acute lymphoblastic leukemia, can be challenging to diagnose. Using data from Children’s Oncology Group AALL0932 physical function study, we sought to determine if parent/guardian proxy-reported responses from the Pediatric Outcomes Data Collection Instrument could identify children with motor or sensory CIPN diagnosed by physical/occupational therapists (PT/OT). Four variables moderately discriminated between children with and without motor CIPN (c-index 0.76, 95% confidence interval [CI]: 0.64–0.84), but sensory and optimism-corrected models had weak discrimination (c-index sensory models 0.65, 95% CI: 0.54–0.74). New proxy-report measures are needed to identify children with PT/OT diagnosed CIPN. © 2023 Wiley Periodicals LLC.
Author Keywords
chemotherapy-induced peripheral neuropathy; motor neuropathy; pediatric acute lymphoblastic leukemia; proxy-reported surveys; sensory neuropathy
Funding details
National Institutes of HealthNIHU10CA095861, U10CA180886, U10CA180899, U10CA98413, U10CA98543, UG1CA189955
National Cancer InstituteNCIT32 CA250803
Doris Duke Charitable FoundationDDCF2021266
St. Baldrick’s FoundationSBF
Division of Cancer Prevention, National Cancer InstituteDCP, NCI
Hyundai Hope On Wheels
Yale Center for Clinical Investigation, Yale School of MedicineYCCI, YSM
Document Type: Article
Publication Stage: Article in Press
Source: Scopus
Racial disparities in access to DBS: results of a real-world U.S. claims data analysis
(2023) Frontiers in Neurology, 14, art. no. 1233684, .
Frassica, M.a , Kern, D.S.b c , Afshari, M.d , Connolly, A.T.a , Wu, C.e , Rowland, N.f , Ramirez-Castaneda, J.g , Ushe, M.h , Salazar, C.f i , Mason, X.j k
a Abbott Laboratories, Austin, TX, United States
b Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
c Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
d Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
e Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
f Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
g Methodist Physicians, Neurosurgery and Neurology Specialists, San Antonio, TX, United States
h Department of Neurology, Washington University, St. Louis, MO, United States
i Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
j Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
k Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
Abstract
Introduction: Deep brain stimulation (DBS) is an effective and standard-of-care therapy for Parkinson’s Disease and other movement disorders when symptoms are inadequately controlled with conventional medications. It requires expert care for patient selection, surgical targeting, and therapy titration. Despite the known benefits, racial/ethnic disparities in access have been reported. Technological advancements with smartphone-enabled devices may influence racial disparities. Real-world evidence investigations can shed further light on barriers to access and demographic disparities for DBS patients. Methods: A retrospective cross-sectional study was performed using Medicare claims linked with manufacturer patient data tracking to analyze 3,869 patients who received DBS. Patients were divided into two categories: traditional omnidirectional DBS systems with dedicated proprietary controllers (“traditional”; n = 3,256) and directional DBS systems with smart controllers (“smartphone-enabled”; n = 613). Demographics including age, sex, and self-identified race/ethnicity were compared. Categorical demographics, including race/ethnicity and distance from implanting facility, were analyzed for the entire population. Results: A significant disparity in DBS utilization was evident. White individuals comprised 91.4 and 89.9% of traditional and smartphone-enabled DBS groups, respectively. Non-White patients were significantly more likely to live closer to implanting facilities compared with White patients. Conclusion: There is great racial disparity in utilization of DBS therapy. Smartphone-enabled systems did not significantly impact racial disparities in receiving DBS. Minoritized patients were more likely to live closer to their implanting facility than White patients. Further research is warranted to identify barriers to access for minoritized patients to receive DBS. Technological advancements should consider the racial discrepancy of DBS utilization in future developments. Copyright © 2023 Frassica, Kern, Afshari, Connolly, Wu, Rowland, Ramirez-Castaneda, Ushe, Salazar and Mason.
Author Keywords
deep brain stimulation; essential tremor; ethnicity; medicare; movement disorder; Parkinson’s disease; race; telehealth
Document Type: Article
Publication Stage: Final
Source: Scopus