Growth in Newborn Circumcisions Performed by Pediatric Urologists and Advanced Practice Providers Between 2010 and 2021 in the United States.

OBJECTIVE: To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade. METHODS: The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year. Simple linear regression assessed growth in proportion of newborn circumcisions performed by pediatric urologists and APPs (nurse practitioner/physician assistant/midwife), over time. RESULTS: In total, 1,006,748 newborn circumcisions (59% inpatient) were identified; while most were performed by obstetricians (45%) or pediatricians (33%); APPs performed 0.9%, and pediatric urologists performed 0.7%. From 2010-2021, the proportion of newborn circumcisions performed by pediatric urologists increased from 0.3% to 2.0% and by APPs in from 0.5% to 2.9% (P < .001 for both). Growth for both pediatric urologists and APPs occurred APPs predominantly from 2016 to 2021. Trends in proportion of newborn circumcision performed by pediatricians was stable [31.5% (2010) and 32.5% (2021)], but decreased for obstetricians [48.8% (2014) and 38.1% (2021)]. CONCLUSION: The proportion of newborn circumcisions performed by pediatric urologists and APPs increased more than 6-fold between 2010 and 2021, though both specialties still perform a minority of newborn circumcisions. These data provide important baseline information for newborn circumcision workforce planning, including evaluating collaborative care models where pediatric urologists train APPs to perform circumcision.

Enhanced cell adhesion and alignment on micro-wavy patterned surfaces.

Various micropatterns have been fabricated and used to regulate cell adhesion, morphology and function. Micropatterns created by standard photolithography process are usually rectangular channels with sharp corners (microgrooves) which provide limited control over cells and are not favorable for cell-cell interaction and communication. This paper proposes a new micropattern with smooth wavy surfaces (micro-waves) to control the position and orientation of cells. To characterize cell growth and responses on the micro-patterned substrates, bovine aortic endothelial cells were seeded onto surfaces with micro-grooves and micro-waves for 24 h. As a result, the cells on the micro-wavy pattern appeared to have a lower death rate and better alignment compared to those on the micro-grooved pattern. In addition, flow-induced shear stress was applied to examine the adhesion strength of cells on the micro-wavy pattern. Results showed that cells adhered to the wavy surface displayed both improved alignment and adhesion strength compared to those on the flat surface. The combination of increased alignment, lower death rate and enhanced adhesion strength of cells on the micro-wavy patterns will offer advantages in potential applications for cell phenotype, proliferation and tissue engineering.