Uncovering the interhospital price variations for vasectomies in the United States.

Due to the historic lack of transparency in healthcare pricing in the United States, the degree of price variation for vasectomy is largely unknown. Our study aims to assess characteristics of hospitals reporting prices for vasectomy as well as price variation associated with hospital factors and insurance status. A cross-sectional analysis was performed in October, 2022 using the Turquoise Database which compiles publicly available hospital pricing data. The database was queried for vasectomy prices to identify the cash (paid by patients not using insurance), commercial (negotiated by private insurers) and Medicare and Medicaid prices for vasectomies. Hospital characteristics of those that reported a price for vasectomy and those that did not were compared and pricing differences based on hospital ownership and reimbursement source were determined using multivariable linear regression analysis. Overall, only 24.7% (1657/6700) of hospitals reported a price for vasectomy. Those that reported a price had more beds (median 117 vs 80, p < 0.001), more physicians (median 1745 vs 1275, p < 0.001). They were also more likely to be nonprofit hospitals (77% vs 14%, p < 0.001) and to be in well-resourced areas (ADI 91.7 vs 94.4, p < 0.001). Both commercial prices and cash prices for vasectomy were lower at nonprofit hospitals than at for-profit hospitals (commercial: $1959.47 vs $2861.56, p < 0.001; cash: $1429.74 vs $3185.37, p < 0.001). Our study highlights the current state of pricing transparency for vasectomy in the United States. Patients may be counseled to consider seeking vasectomy at a nonprofit hospital to reduce their costs, especially when paying with cash. These findings also suggest a need for new policies to target areas with decreased price transparency to reduce price disparities.

Twitter Footprint and the Match in the COVID-19 Era: Understanding the Relationship between Applicant Online Activity and Residency Match Success.

INTRODUCTION: The dramatic reduction of clinical and research activities within medical and surgical departments during COVID-19, coupled with the inability of medical students to engage in research, away rotations and academic meetings, have all posed important implications on residency match. METHODS: Using Twitter application programming interface available data, 83,000 program-specific and 28,500 candidate-specific tweets were extracted for the analysis. Applicants to urology residency were identified as matched vs unmatched based on 3-level identification and verification. All elements of microblogging were captured through Anaconda Navigator. The primary endpoint was residency match, assessed as correlation to Twitter analytics (ie retweets, tweets). The final list of matched/unmatched applicants through this process was cross-referenced with internal validation of information obtained from the American Urological Association. RESULTS: A total of 28,500 English language posts from 250 matched and 45 unmatched applicants were included in the analysis. Matched applicants generally showed higher number of followers (median 171 [IQR 88-317.5] vs 83 [42-192], p=0.001), tweet likes (2.57 [1.53-4.52] vs 1.5 [0.35-3.03], p=0.048), and recent and total manuscripts (1 [0-2] vs 0 [0-1], p=0.006); 1 [0-3] vs 0 [0-1], p=0.016) in comparison to the unmatched cohort. On multivariable analysis, after adjusting for location, total number of citations and manuscripts, being a female (OR 4.95), having more followers (OR 1.01), individual tweet likes (OR 1.011) and total number of tweets (OR 1.02) increased overall odds of matching into a urology residency. CONCLUSIONS: Our study of the 2021 urology residency application cycle and use of Twitter highlighted distinct differences among matched and unmatched applicants and their respective Twitter analytics, highlighting a potential professional development opportunity offered by social media in underscoring applicants' profiles.

The small molecule drug CBL0137 increases the level of DNA damage and the efficacy of radiotherapy for glioblastoma.

Glioblastoma (GBM) is an incurable brain tumor with inevitable recurrence. This is in part due to a highly malignant cancer stem cell (CSC) subpopulation of tumor cells that is particularly resistant to conventional treatments, including radiotherapy. Here we show that CBL0137, a small molecule anti-cancer agent, sensitizes GBM CSCs to radiotherapy. CBL0137 sequesters the FACT (facilitates chromatin transcription) complex to chromatin, resulting in cytotoxicity preferentially within tumor cells. We show that when combined with radiotherapy, CBL0137 inhibited GBM CSC growth and resulted in more DNA damage in the CSCs compared to irradiation or drug alone. Using an in vivo subcutaneous model, we showed that the frequency of GBM CSCs was reduced when tumors were pretreated with CBL0137 and then exposed to irradiation. Survival studies with orthotopic GBM models resulted in significantly extended survival for mice treated with combinatorial therapy. As GBM CSCs contribute to the inevitable recurrence in patients, targeting them is imperative. This work establishes a new treatment paradigm for GBM that sensitizes CSCs to irradiation and may ultimately reduce tumor recurrence.