Nasofrontal encephalocele in a child, associated with a nasal dermal sinus in his mother: familial cranial malformations. Illustrative case.

BACKGROUND: Dermal sinuses and encephaloceles are uncommon central nervous system malformations. The occurrence of these malformations in different members of a family is very rare. OBSERVATIONS: This report documents the unique case of a 10-month-old boy with a frontonasal encephalocele, born to a mother with a nasal dermal sinus. These two specific neural tube defects have not been previously reported as occurring between parent and child. LESSONS: This case demonstrates potential heritable links in central nervous system malformations through the occurrence of a frontonasal encephalocele in a child born to a mother with a dermal sinus. The connection between these two malformations in a heritable manner suggests a potential need for further research into the genetic pathogenesis of such defects to predict them more accurately within families. https://thejns.org/doi/10.3171/CASE23727.

Corrigendum: CD8 T cell response and its released cytokine IFN-γ are necessary for lung alveolar epithelial repair during bacterial pneumonia.

[This corrects the article DOI: 10.3389/fimmu.2023.1268078.].

Sweet potato (Ipomoea batatas L.) genotype selection using advanced indices and statistical models: A multi-year approach.

In Bangladesh, sweet potato holds the fourth position as a crucial carbohydrate source, trailing rice, wheat, and potato. However, locally grown sweet potato varieties often display limited stability and yield. To tackle this challenge, diverse selection methods and statistical models were utilized to pinpoint sweet potato genotypes showcasing both stability and superior yield and quality traits. In the initial two years, multiple selection methods were employed to narrow down the collections based on preferences for yield and its contributing traits. Subsequently, a multi-environment trial (MET) was conducted in the following year to pinpoint superior and stable genotypes with desirable yield and quality characteristics. An integrated approach involving the Multi-Trait Genotype Ideotype Distance Index (MGIDI), Factor Analysis and Ideotype-Design (FAI-BLUP), and Smith-Hazel Index (SH) led to the identification of 71 superior sweet potato genotypes out of a total of 351 in the initial growing season. In the subsequent season, the MGIDI selection index was applied to the 71 genotypes, resulting in the selection of 11 top-performing genotypes. This selection process was complemented by a detailed analysis of the strengths and weaknesses of the selected genotypes. In the MET, the mixed effect model, specifically the linear mixed model (LMM), identified significant genotypic and genotype-environment interaction (GEI) variances. This points to elevated heritability and selection accuracy, ultimately boosting the model's reliability. By combining the strengths of LMM and additive main effects and multiplicative interaction (AMMI), the best linear unbiased prediction (BLUP) index identified H20 as the top-performing genotype for marketable root yield (MRY), H37 for dry weight of root (DW), H8 for beta carotene (BC) and H41 for vitamin c (VC). These genotypes surpassed the overall average in the WAAS index. For simultaneous stability and high performance, the WAASBY index selected H37 for MRY, H6 for DW, H61 for BC, and H3 for VC. Finally, genotypes H3 and H20 were selected using multi-trait stability index (MTSI), as they possessed high performance and stability. Based on the selection sense, the objective has been achieved with regards to the trait MRW, which serves as a major criterion for a superior variety of sweet potato.

Impact of environmental pollutants on pediatric brain tumor incidence in New Jersey.

OBJECTIVE: The relationship between environmental contaminants and brain tumor incidence in adults has been thoroughly explored but research into how these contaminants affect pediatric brain tumor (PBT) incidence has not been explored. Children, typically having more limited geographical movement and thus more consistent environmental contaminant exposure, might offer more reliable insights into which environmental contaminants affect the incidence of brain tumors. The present study is the first to focus on exploring whether a possible association exists between the incidence of PBTs and exposure to environmental pollutants in New Jersey (NJ). METHODS: Linear regressions were run between PBT incidence and the concentration of air quality pollutants such as Ozone (O3), Particulate Matter 2.5 (PM2.5), Particulate Matter 10 (PM10), and Carbon Monoxide (CO). Similarly, linear regressions were run between PBT incidence and Elevated Blood Lead Levels (BLL). RESULTS: The study observed a significant positive relationship between O3 and PBT incidence (ß = 0.34, p = 0.028). However, the relationship between PBT incidence, and environmental pollutants such as CO (ß = 0.0047, p = 0.098), PM2.5 (ß = -0.2624, p = 0.74), and PM10 (ß = -0.7353, p = 0.073) were found to be nonsignificant. For elevated BLL, nonsignificant relationships with PBT incidence were observed at 10-14 µg/dL (ß = -39.38, p = 0.30), 15-19 µg/dL (ß = -67.00, p = 0.21), and 20-44 µg/dL (ß = -201.98, p = 0.12). CONCLUSIONS: The results indicate a possible impact of O3 on the incidence of PBTs in NJ. In contrast to the significant links found in prior studies of adult brain tumors, the associations between PBT occurrence and particulate matter were not significant. These findings highlight the importance of further investigating how environmental factors, especially O3, relate to PBTs.

Do Iliac Screws Placed Close to the Sciatic Notch Have Greater Pullout Strength?

BACKGROUND AND OBJECTIVES: Optimal iliac screw position in relation to the sciatic notch remains unknown. In 12 cadavers undergoing S2 alar-iliac (S2AI) screw placement, we tested the pullout strength of screws placed in proximity to the sciatic notch (≤5 mm) vs farther away from the sciatic notch (>5 mm). METHODS: A biomechanical, cadaver-based study was performed on 12 cadavers undergoing bilateral S2AI screw insertion. The position of the S2AI screw regarding the sciatic notch was dichotomized as ≤5 mm from the sciatic notch on the right side and >5 mm on the left side, confirmed using c-arm fluoroscopy. The primary outcome was the pullout strength of the screw (N). Secondary outcomes were stiffness (N/mm), yield force (N), and work to failure (N mm). Ischial tuberosity was embedded into polymethyl methacrylate and secured to a custom 3-axis vise grip mounted to a 14.5-kN load cell. Pullout testing was performed at 5 mm/min. Force and displacement data were collected at 100 Hz and evaluated using MATLAB. The Mann-Whitney test was performed. RESULTS: Of 24 S2AI screws, 3 screws could not be tested because of cement-bone interface failure. A positive though nonsignificant trend of screw pullout strength was found for screws close to the notch compared with those farther from the notch (861.8 ± 340.7 vs 778.7 ± 350.8 N, P = .859). Similarly, screws close to the notch demonstrated a higher trend of stiffness (149.4 ± 145.4 vs 111.34 ± 128.2 N/mm, P = .320) and force to yield (806.9 ± 352.0 vs 618.6 ± 342.9 N, P = .455). Conversely, screws farther from the notch had a higher but similarly nonsignificant area under the force-displacement curve (10 867.0 ± 9565.0 vs 14 196.6 ± 9578.3 N mm, P = .455), which might be due to excess sheer/translation force that could not be reliably quantified. CONCLUSION: Although placing S2AI screws ≤5 mm of the sciatic notch provided stronger fixation in 3 of 4 biomechanical testing categories, these results were not statistically significant. Therefore, placing S2AI screws ≤5 mm of the sciatic notch did not provide stronger fixation.

Development and evaluation of Order of Magnitude (OM): a virtual reality-based visual field analyzer for glaucoma detection.

PURPOSE: This study introduces the Order of Magnitude (OM), a cost-effective, indigenous, virtual reality-based visual field analyzer designed for detecting glaucomatous visual field loss. METHODS: The OM test employs a two-step supra-thresholding algorithm utilizing stimuli of 0.43°diameter (equivalent to Goldmann size III) at low and high thresholds. A comparative analysis was conducted against the Humphrey visual field (HVF) test, considered the gold standard in clinical practice. Participants, including those with glaucoma and normal individuals, underwent comprehensive eye examinations alongside the OM and HVF tests between April and October 2019. Diagnostic sensitivity and specificity of the OM test were assessed against clinical diagnoses made by specialists. RESULTS: We studied 157 eyes (74 glaucomatous, 83 control) of 152 participants. Results demonstrated a high level of reliability for both OM and HVF tests, with no significant difference observed (P = 0.19, Chi-square test). The sensitivity and specificity of the OM test were found to be 93% (95% CI 86-100%) and 83% (95% CI 72.4-93%), respectively, while the HVF test showed sensitivity and specificity of 98% (95% CI 93.9-100%) and 83% (95% CI 73.9-92.8%), respectively. CONCLUSION: These findings suggest that the OM test is non-inferior to the reference standard HVF test in identifying glaucomatous visual field loss.

TennCare Disenrollment Led To Increased Eviction Filings And Evictions In Tennessee Relative To Other Southern States.

Previous research suggests that enrolling in Medicaid reduces evictions by improving health and providing financial protection. However, previous studies have not examined whether the loss of Medicaid affects eviction outcomes. We analyzed eviction filings and completed evictions after a large, mandatory Medicaid disenrollment in Tennessee in 2005. We conducted a difference-in-differences analysis using data from the Eviction Lab at Princeton University and found that relative to other southern states, the TennCare disenrollment led to a 27.6 percent greater increase in the average annual number of eviction filings at the county level during the period 2005-09 and a 24.5 percent greater increase in the average annual number of completed evictions at the county level during that same period. Our findings have implications for the housing stability of Medicaid recipients today, many of whom are being disenrolled because of the unwinding of the Medicaid continuous enrollment provision that is occurring across the country. To protect housing stability for people disenrolled from Medicaid, policy makers may wish to consider new initiatives aimed at preventing an increase in eviction.

Use of Behavioral Health Treatment Among Parenting Women With Opioid Use Disorder in the United States.

OBJECTIVE: To examine use of mental health treatment, substance use disorder treatment, and perceived barriers to treatment by whether a major depressive episode occurred during the past year among parenting women with opioid use disorder. DESIGN: Secondary analysis of survey data from the National Survey on Drug Use and Health, 2015-2019. SETTING: United States. PARTICIPANTS: Women aged 18 to 44 years with opioid use disorder and at least one child in the household. METHODS: We computed descriptive statistics for demographic characteristics, treatment by major depressive episode status, and barriers to treatment by major depressive episode status. We conducted multinomial logistic regression to examine associations among demographic characteristics, major depressive episode status, and type of treatment. RESULTS: Of the 36% of respondents in our weighted sample (N ≈ 254,300) who experienced major depressive episode, 35% received substance use disorder and mental health treatment, and 27% did not receive any form of treatment. We found that identification as a person of color was significantly associated with a lower relative risk of receiving any type of treatment. Frequently reported barriers to treatment included affordability, access, and stigma. CONCLUSION: Respondents with opioid use disorder and co-occurring major depressive episode did not obtain necessary treatment. Barriers to treatment, including affordability, access to treatment, and stigma, need to be addressed, particularly among women of color.

The association between rurality, dual Medicare/Medicaid eligibility and chronic conditions with telehealth utilization: An analysis of 2019-2020 national Medicare claims.

INTRODUCTION: Telehealth services have the potential to increase healthcare access among underserved populations, such as rural residents and racial/ethnic minority groups. The COVID-19 public health emergency led to unprecedented growth in telehealth utilization, but evidence suggests the growth has not been equitable across all patient populations. This study aimed to explore whether telehealth utilization and expansion changed equitably from 2019 to 2020 among sub-groups of Medicare beneficiaries. METHODS: We conducted an analysis of telehealth utilization among a 20% random sample of 2019-2020 Medicare beneficiaries on a national level. We fit multivariable logistic regression models and calculated average marginal effects (AME) to assess the association between demographic and clinical characteristics on telehealth utilization. RESULTS: We found telehealth utilization was less likely among non-Hispanic Black/African-American (2019: adjusted odds ratio [aOR] = 0.77, AME = -0.15; 2020: aOR = 0.85, AME = -3.50) and Hispanic (2019: aOR = 0.79, AME = -0.13; 2020: aOR = 0.87, AME = -2.89) beneficiaries, relative to non-Hispanic White beneficiaries in both 2019 and 2020, with larger disparities in 2020. Rural beneficiaries were more likely to utilize telehealth than urban beneficiaries in 2019 (aOR = 2.62, AME = 0.84), but less likely in 2020 (aOR = 0.57, AME = -14.47). In both years, dually eligible Medicare/Medicaid beneficiaries were more likely than non-dually eligible beneficiaries to utilize telehealth (2019: aOR = 4.75, AME = 0.84; 2020: aOR = 1.34, AME = 2.25). However, the effects of dual eligibility and rurality changed in both models as the number of chronic conditions increased. DISCUSSION: We found evidence of increasing disparities in telehealth utilization among several Medicare beneficiary sub-groups in 2020 relative to 2019, including individuals of minority race/ethnicity, rural residents, and dually eligible beneficiaries, with disparities increasing among individuals with more chronic conditions. Although telehealth has the potential to address health inequities, our findings suggest that many of the patients in greatest need of healthcare are least likely to utilize telehealth services.

Unveiling microplastics pollution in a subtropical rural recreational lake: A novel insight.

While global attention has been primarily focused on the occurrence and persistence of microplastics (MP) in urban lakes, relatively little attention has been paid to the problem of MP pollution in rural recreational lakes. This pioneering study aims to shed light on MP size, composition, abundance, spatial distribution, and contributing factors in a rural recreational lake, 'Nikli Lake' in Kishoreganj, Bangladesh. Using density separation, MPs were extracted from 30 water and 30 sediment samples taken from ten different locations in the lake. Subsequent characterization was carried out using a combination of techniques, including a stereomicroscope, Fourier transform infrared spectroscopy (FTIR) and field emission scanning electron microscopy (FE-SEM). The results showed a significant prevalence of MPs in all samples, with an average amount of 109.667 ± 10.892 pieces/kg3 (dw) in the sediment and 98.167 ± 12.849 pieces/m3 in the water. Small MPs (<0.5 mm), fragments and transparent colored particles formed the majority, accounting for 80.2%, 64.5% and 55.3% in water and 78.9%, 66.4% and 64.3% in sediment, respectively. In line with global trends, polypropylene (PP) (53%) and polyethylene (PE) (43%) emerged as the predominant polymers within the MPs. MP contents in water and sediment showed positive correlations with outflow, while they correlated negatively with inflow and lake depth (p > 0.05). Local activities such as the discharge of domestic sewage, fishing waste and agricultural runoff significantly influence the distribution of polypropylene. Assessment of pollution factor, pollution risk index and pollution load index values at the sampling sites confirmed the presence of MPs, with values above 1. This study is a baseline database that provides a comprehensive understanding of MP pollution in the freshwater ecosystem of Bangladesh, particularly in a rural recreational lake. A crucial next step is to explore ecotoxicological mechanisms, legislative measures and future research challenges triggered by MP pollution.

The estimated prevalence of osteoporosis in Bahrain: a multi-centered-based study.

OBJECTIVES: the primary aim of this study was to examine the prevalence and risk factors of low bone mineral density in Bahrain. METHODS: this was a retrospective study, which targeted a cohort of 4822 Bahraini subjects (mean age 59.36 years: 93% females). Demographic data and results of lumbar and femur DEXA scan for the targeted sample, over the period 2016-2018, were retrieved from four hospitals. RESULTS: The prevalence of low BMD was 62.3% (46.4% had osteopenia and 15.9% had osteoporosis). The highest rate of osteopenia was detected at the age group younger than 44 years. However, with increasing age, the rate of osteopenia declined, whereas osteoporosis increased (P < 0.001). Females were found to be at higher risk of developing both osteopenia (45.8%) and osteoporosis (18.1%) compared to males (39% and 12.4%, respectively) (P < 0.001). Postmenopausal women exhibited higher rates of low BMD (42.4% osteopenia, 22.3% osteoporosis) compared to elderly men (30.9% osteopenia, 9% osteoporosis). CONCLUSIONS: We reported high prevalence of osteopenia and osteoporosis in Bahrain. Low BMD was more common in females, especially in postmenopausal women. Highest prevalence of osteopenia happened at young age. Therefore, we advocate screening at younger age than previously recommended.

Imipridones inhibit tumor growth and improve survival in an orthotopic liver metastasis mouse model of human uveal melanoma.

Purpose: Uveal melanoma (UM) is a highly aggressive disease with very few treatment options. We previously demonstrated that mUM is characterized by high oxidative phosphorylation (OXPHOS). Here we tested the anti-tumor, signaling and metabolic effects of imipridones, CLPP activators which reduce OXPHOS indirectly and have demonstrated safety in patients. Experimental Design: We assessed CLPP expression in UM patient samples. We tested the effects of imipridones (ONC201, ONC212) on the growth, survival, signaling and metabolism of UM cell lines in vitro, and for therapeutic effects in vivo in UM liver metastasis models. Results: CLPP expression was confirmed in primary and mUM patient samples. ONC201/212 treatment of UM cell lines in vitro decreased OXPHOS effectors, inhibited cell growth and migration, and induced apoptosis. ONC212 increased metabolic stress and apoptotic pathways, inhibited amino acid metabolism, and induced cell death-related lipids. ONC212 also decreased tumor burden and increased survival in vivo in two UM liver metastasis models. Conclusion: Imipridones are a promising strategy for further testing and development in mUM.

Assessment of Pregnancy-Related Telehealth Interventions in the United States: A 10-Year Scoping Review.

Introduction: Telehealth use in obstetrics has been demonstrated to improve efficiency, access to care, and pregnancy outcomes. Despite reported successful implementation of these programs, information regarding the program variations and its impact on health care costs and outcomes are scarce. Methods: This is a scoping review of pregnancy-related telehealth studies to understand the current landscape of pregnancy-related telehealth interventions as well as to subset those that are used in high-risk pregnancies. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to guide this review. Results: A total of 70 articles were included in this scoping review. Of those, 53 (75.7%) studies included a pregnant population and 17 (24.3%) studies focused on a rural and/or urban population. Most studies (n = 56; 80%) included some form of synchronous interaction between provider and participant. Patient outcomes included maternal/infant health outcomes (n = 41; 44.1%), patient satisfaction (n = 9; 9.7%), and attendance/compliance (n = 5; 5.4%). Provider-level outcomes included knowledge change (n = 11; 11.8%) and self-efficacy (n = 3; 3.2%). Other outcomes included assessment of costs and patient/provider feasibility and acceptability of the intervention. Overall, there has been a growing trend in articles published on pregnancy-related telehealth studies since 2011, with 2018 having the most publications in a single year. Conclusion: This review suggests a steadily growing body of literature on pregnancy-related telehealth interventions; however, more research is needed to better understand outcomes of telehealth for pregnancy-related care, especially related to patient satisfaction, health disparities, and cost-benefit.

The path of microplastics through the rare biodiversity estuary region of the northern Bay of Bengal.

Due to its harmful effects on ecosystems and human health, microplastic (MP) pollution has become a significant environmental problem on a global scale. Although MPs' pollution path and toxic effects on marine habitats have been examined worldwide, the studies are limited to the rare biodiversity estuary region of Hatiya Island from the northern Bay of Bengal. This study aimed to investigate the MP pollution path and its influencing factors in estuarine sediments and water in rare biodiversity Hatiya Island in the northern Bay of Bengal. Sixty water and sediment samples were collected from 10 sampling sites on the Island and analyzed for MPs. The abundance of MPs in sediment ranged from 67 to 143 pieces/kg, while the abundance in water ranged from 24.34 to 59 pieces/m3. The average concentrations of MPs in sediment and water were 110.90 ± 20.62 pieces/kg and 38.77 ± 10.09 pieces/m3, respectively. Most identified MPs from sediment samples were transparent (51%), while about 54.1% of the identified MPs from water samples were colored. The fragment was the most common form of MP in both compartments, with a value of 64.6% in sediment samples and 60.6% in water samples. In sediment and water samples, almost 74% and 80% of MP were <0.5 mm, respectively. Polypropylene (PP) was the most abundant polymer type, accounting for 51% of all identified polymers. The contamination factor, pollution load index, polymer risk score, and pollution risk score values indicated that the study area was moderately polluted with MPs. The spatial distribution patterns and hotspots of MPs echoed profound human pathways. Based on the results, sustainable management strategies and intervention measures were proposed to reduce the pollution level in the ecologically diverse area. This study provides important insights into evaluating estuary ecosystem susceptibility and mitigation policies against persistent MP issues.

Bioaccumulation and sources of metal(loid)s in fish species from a subtropical river in Bangladesh: a public health concern.

Toxic metals and freshwater fish's metalloid contamination are significant environmental concerns for overall public health. However, the bioaccumulation and sources of metal(loids) in freshwater fishes from Bangladesh still remain unknown. Thus, the As, Pb, Cd, and Cr concentrations in various freshwater fish species from the Rupsha River basin were measured, including Tenualosa ilisha, Gudusia chapra, Otolithoides pama, Setipinna phasa, Mystus vittatus, Glossogobius giuris, and Pseudeutropius atherinoides. An atomic absorption spectrophotometer was used to determine metal concentrations. The mean concentrations of metal(loids) in the fish muscle (mg/kg) were found to be As (1.53) > Pb (1.25) > Cr (0.51) > Cd (0.39) in summer and As (1.72) > Pb (1.51) > Cr (0.65) > Cd (0.49) in winter. The analyzed fish species had considerably different metal(loid) concentrations with seasonal variation, and the distribution of the metals (loids) was consistent with the normal distribution. The demersal species, M. vittatus, displayed the highest bio-accumulative value over the summer. However, in both seasons, none of the species were bio-accumulative. According to multivariate statistical findings, the research area's potential sources of metal(loid) were anthropogenic activities linked to geogenic processes. Estimated daily intake, target hazard quotient (THQ), and carcinogenic risk (CR) were used to assess the influence of the risk on human health. The consumers' THQs values were < 1, indicating that there were no non-carcinogenic concerns for local consumers. Both categories of customers had CRs that fell below the permissible range of 1E - 6 to 1E - 4, meaning they were not at any increased risk of developing cancer. The children's group was more vulnerable to both carcinogenic and non-carcinogenic hazards. Therefore, the entry of metal(loids) must be regulated, and appropriate laws must be used by policymakers.

Health Services Use Among Children With Prenatal Substance Exposure or Neonatal Abstinence Syndrome.

OBJECTIVE: Infants with prenatal substance exposure or neonatal abstinence syndrome (NAS) use health services more often than other children; however, little is known about their use of mental health services and psychotropic medication. METHODS: The sample (N=1,004,085) consisted of infants born in 2016 in 38 states who were followed through the fifth year of life and enrolled each year in Medicaid or the Children's Health Insurance Program. Infants with prenatal substance exposure or NAS were identified with ICD-10 diagnosis codes; procedure and revenue codes documented their service use. RESULTS: Rates of any mental health visit and of psychotropic medication use were higher among infants with prenatal substance exposure or NAS compared with infants without either condition; these patterns persisted during most years of the 5-year study. CONCLUSIONS: Infants' elevated mental health services use through their first 5 years of life highlights the importance of early screening and subsequent engagement in school-based mental health interventions.

Placement of a Kickstand Rod in Adult Spinal Deformity Surgery: A Simple 8-Step Process With Intraoperative Images and Video.

BACKGROUND AND OBJECTIVES: In adult spinal deformity (ASD) surgery, operative correction of coronal malalignment remains a challenging surgical task. Given the proven effectiveness and longevity of the kickstand rod (KSR) technique and its powerful ability to correct coronal malalignment, this technique is an important tool to have available. Therefore, we sought to provide a simple 8-step description of the KSR technique using intraoperative images and video in a patient undergoing combined sagittal and coronal malalignment correction. METHODS: A 68-year-old female with a previous history of T11-S1 posterior spinal fusion presented with mid thoracic back pain, leg paresthesias, and a right-leaning posture. The patient underwent a T4-pelvis extension of fusion, T8-11 posterior column osteotomies, and placement of a right-sided KSR to address her coronal malalignment. RESULTS: The KSR technique is summarized in the following steps: (1) place kickstand screw, (2) place contralateral main rod and tighten all set plugs, (3) place ipsilateral main rod and keep rod long distally, (4) place a domino in the lower/mid thoracic area, (5) place the KSR and leave the rod long proximally, (6) tighten the ipsilateral main rod above the domino, (7) loosen the ipsilateral main rod below the domino, and (8) place a rod gripper below the domino and distract. Postoperatively, the coronal vertical axis improved from 4.8 to 0.6 cm, and the sagittal vertical axis improved from 9.5 to 3.9 cm. CONCLUSION: The current case report provides a simple 8-step description of the KSR technique to improve coronal malalignment accompanied by intraoperative images and video.

Psychotropic Medication and Psychosocial Service Use Among Transition Age Youth With Autism Spectrum Disorder.

People with autism spectrum disorder (ASD) experience high rates of psychotropic medication utilization and barriers to psychosocial services, yet limited literature explores use of these services and the association between a mental health condition (MH) and use. Using national multipayer claims data, this study estimates a multinomial logistic regression model to discern psychotropic medication and psychosocial service use among transition age youth (TAY) with ASD (12-26 years; N = 52,083) compared to a matched cohort of those without ASD (12-26 years; N = 52,083). Approximately one-third of TAY with ASD and no MH condition receive only psychotropic medication and the likelihood of using both psychosocial services and medication is higher only when TAY with ASD have a co-occurring MH condition.