RESUMEN
Positional plagiocephaly is a craniofacial condition resulting from infant positioning that applies pressure consistently to a part of the skull. This study analyzed the prevalence of, and costs associated with orthotic helmet treatment for positional plagiocephaly and assessed inequities in treatment between medically underserved areas (MUAs) and non-MUAs using health insurance claims data from the Center for Health Information and Analysis (CHIA) in Massachusetts for the years 2016-2021. The mean percentage of patients receiving orthotic helmet therapy was 4.3% (SD=0.49, 95% CI=3.88-4.91, P=0.44). MUAs contained 37.2% of patients with positional plagiocephaly and 2.9% of MUA patients were treated with helmets compared with 5.2% of non-MUA patients (P<0.01). There was a significant decline in the percentage of patients prescribed helmeting therapy over the course of the study (P<0.01). The average copay amount for public insurance was $0.00, and for private insurance, it was $559.8 (SD=160.7, 95% CI=529.1-590.5, P<0.01). Of 3295 claims for orthotic helmet treatment, 92 were fully denied (2.8%). Private insurers issued more fully denied claims (3.8%) than public insurance (1.1%) (P<0.01). We found that public insurance is favorable for patients seeking treatment due to a lower likelihood of full denial and lower copayments. In addition, we found that there is a significant disparity in the prevalence of helmet treatment in MUAs, and the percentage of patients treated with helmeting therapy has declined over time.
RESUMEN
The freshwater sponge Ephydatia muelleri and its Chlorella-like algal partner is an emerging model for studying animal: algal endosymbiosis. The sponge host is a tractable laboratory organism, and the symbiotic algae are easily cultured. We took advantage of these traits to interrogate questions about mechanisms that govern the establishment of durable intracellular partnerships between hosts and symbionts in facultative symbioses. We modified a classical experimental approach to discern the phagocytotic mechanisms that might be co-opted to permit persistent infections, and identified genes differentially expressed in sponges early in the establishment of endosymbiosis. We exposed algal-free E. muelleri to live native algal symbionts and potential food items (bacteria and native heat-killed algae), and performed RNA-Seq to compare patterns of gene expression among treatments. We found a relatively small but interesting suite of genes that are differentially expressed in the host exposed to live algal symbionts, and a larger number of genes triggered by host exposure to heat-killed algae. The upregulated genes in sponges exposed to live algal symbionts were mostly involved in endocytosis, ion transport, metabolic processes, vesicle-mediated transport, and oxidation-reduction. One of the host genes, an ATP-Binding Cassette transporter that is downregulated in response to live algal symbionts, was further evaluated for its possible role in the establishment of the symbiosis. We discuss the gene expression profiles associated with host responses to living algal cells in the context of conditions necessary for long-term residency within host cells by phototrophic symbionts as well as the genetic responses to sponge phagocytosis and immune-driven pathways.