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Peterman N, Shivdasani K, Pagani N, Mann R, Naik A, Pekas D, Sun D. National Trends in Orthopaedic Pain Management from 2016 to 2020. J Am Acad Orthop Surg 2024; 32:e503-e513. [PMID: 38422494 DOI: 10.5435/jaaos-d-23-00806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Effective pain management is vital in orthopaedic care, impacting postoperative recovery and patient well-being. This study aimed to discern national and regional pain prescription trends among orthopaedic surgeons through Medicare claims data, using geospatial analysis to ascertain opioid and nonopioid usage patterns across the United States. METHODS Physician-level Medicare prescription databases from 2016 to 2020 were filtered to orthopaedic surgeons, and medications were categorized into opioids, muscle relaxants, anticonvulsants, and NSAIDs. Patient demographics were extracted from a Medicare provider demographic data set, while county-level socioeconomic metrics were obtained primarily from the American Community Survey. Geospatial analysis was conducted using Geoda software, using Moran I statistic for cluster analysis of pain medication metrics. Statistical trends were analyzed using linear regression, Mann-Whitney U test, and multivariate logistic regression, focusing on prescribing rates and hotspot/coldspot identification. RESULTS Analysis encompassed 16,505 orthopaedic surgeons, documenting more than 396 million days of pain medication prescriptions: 57.42% NSAIDs, 28.57% opioids, 9.84% anticonvulsants, and 4.17% muscle relaxants. Annually, opioid prescriptions declined by 4.43% ( P < 0.01), while NSAIDs rose by 3.29% ( P < 0.01). Opioid prescriptions dropped by 210.73 days yearly per surgeon ( P < 0.005), whereas NSAIDs increased by 148.86 days ( P < 0.005). Opioid prescriptions were most prevalent in the West Coast and Northern Midwest regions, and NSAID prescriptions were most prevalent in the Northeast and South regions. Regression pinpointed spine as the highest and hand as the lowest predictor for pain prescriptions. DISCUSSION On average, orthopaedic surgeons markedly decreased both the percentage of patients receiving opioids and the duration of prescription. Simultaneously, the fraction of patients receiving NSAIDs dramatically increased, without change in the average duration of prescription. Opioid hotspots were located in the West Coast, Utah, Colorado, Arizona, Idaho, the Northern Midwest, Vermont, New Hampshire, and Maine. Future directions could include similar examinations using non-Medicare databases.
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Affiliation(s)
- Nicholas Peterman
- From the Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL (Peterman, Shivdasani, Mann, and Naik), Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Pagani and Sun), Department of Orthopaedic Surgery, Musculoskeletal Education and Research Center, Carilion Clinic, Roanoke, VA (Dr. Pekas)
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Pozin M, Nyaeme M, Peterman N, Jagasia A. Geospatial evaluation of access to otolaryngology care in the United States. Laryngoscope Investig Otolaryngol 2024; 9:e1239. [PMID: 38525122 PMCID: PMC10960241 DOI: 10.1002/lio2.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/25/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives This county-level epidemiological study evaluated the travel distance to the nearest otolaryngologist for continental US communities and identified socioeconomic differences between low- and high-access regions. Methods Geospatial analysis of publicly available 2015-2022 NPI records was combined with US census data to identify geospatial gaps in otolaryngologist distribution. Moran's index geospatial clustering in distance to the nearest county with an otolaryngologist was used as the core metric for differential access determination. Univariate logistic analysis was conducted between low- and high-access counties for 20 socioeconomic and demographic variables. Results Nationally, the average person was 22 miles from an otolaryngologist. 444 counties were identified as geospatially "low access" with increased travel distance in the Midwest, Great Planes, and Nevada with a median of 47 miles. 1231 counties in the Eastern United States and Western Coast were identified as "high access" with a 3-mile median travel distance. Areas of low access to otolaryngological care had smaller median populations (12,963 vs. 558,306), had smaller percent Black and Asian populations (2% vs. 11%, 1% vs. 5%, respectively), had a greater percent American Indian population (2% vs. 1%), were less densely populated (8 vs. 907 people per square mile), had fewer percent college graduates (20% vs. 34%), and fewer otolaryngologists per county (median: 0.01-20). Conclusion These findings highlight disparity in otolaryngology care in the United States and the need for otolaryngology funding initiatives in the Midwest and Great Plains regions. Level of Evidence Level 3.
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Affiliation(s)
| | - Mark Nyaeme
- Carle Illinois College of MedicineUrbanaIllinoisUSA
| | | | - Ashok Jagasia
- Carle Illinois College of MedicineUrbanaIllinoisUSA
- Department of Otolaryngology‐Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
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Naik A, Peterman N, Berke C, Furey CG, DiDomenico J, Abbatematteo J, Detchou D, Catapano JS, Snyder LA, Lawton MT, Stroink A, Arnold PM. Trends in medical device company payments in neurosurgery: a nationwide, multidatabase, geospatial analysis. J Neurosurg 2024; 140:1091-1101. [PMID: 37890179 DOI: 10.3171/2023.8.jns23276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/14/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE Industry partnerships help advance the field of neurosurgery. Given the nature of the field and its close relationship with innovation, neurosurgeons frequently partner with the medical device industry to advance technology and improve outcomes. However, this can create important ethical concerns for patients. In this paper, the authors sought to comprehensively study how physician payments from medical device companies have changed and what geographic parameters influence the trends observed over the years. METHODS The authors queried and merged several large databases, including Medicare and Medicaid provider usage data and databases from the Open Payments Program, National Plan and Provider Enumeration System, and US Census Bureau. Geospatial analysis was performed using Moran's I and II clustering. Univariate and multivariable analyses were performed using the Mann-Whitney U-test and geospatially weighted multivariable regression for hot spot and cold spot membership. RESULTS Data for 952 counties across the continental United States were analyzed. Ninety-seven counties constituted geographic hot spots. These hot spots were primarily concentrated in Florida, the New York-Pennsylvania region, central Colorado, and southwestern United States. Independent predictors of hot spot membership included greater unemployment rates, the percentage of White patients, the presence of mobile homes, and the percentage of county Hispanic and Black populations. Company-based differences were examined. The vast majority of Medtronic's payments were in the form of royalties and licensing (86.6%). Royalties and licensing accounted for the majority of payments for DePuy (69.4%), Globus Medical (62%), and NuVasive (77.1%). In contrast, other companies, such as Boston Scientific, opted to pay physicians in the form of ownership and investment interests (42.1%). The impact of the COVID-19 pandemic was also assessed. During the onset of the pandemic in 2020, physician payments fell or remained the same across all regions with the exception of the South Atlantic region. However, it was observed that nearly all regions rebounded, with stark elevations in physician payments immediately in 2021. CONCLUSIONS This analysis demonstrates that there are national hot spots and cold spots of physician payments, and offers some social, economic, and company-dependent predictors that may influence the magnitude of payments. Further analysis is needed to better understand this clinical-commercial partnership in healthcare, specifically within neurosurgical practice.
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Affiliation(s)
- Anant Naik
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Nicholas Peterman
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Chandler Berke
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Charuta G Furey
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Joseph DiDomenico
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Joseph Abbatematteo
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Donald Detchou
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Joshua S Catapano
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Laura A Snyder
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Michael T Lawton
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Ann Stroink
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Paul M Arnold
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
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Peterman N, Shivdasani K, Naik A, Yeo E, Simon J, Garst J, Moawad C, Stauffer C, Kaptur B, Arnold PM. Understanding Geospatial Trends in Lumbar Fusion Incidence and Technique in Medicare Populations. Spine (Phila Pa 1976) 2024; 49:128-137. [PMID: 37612890 DOI: 10.1097/brs.0000000000004807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
STUDY DESIGN Retrospective study with epidemiologic analysis of public Medicare data. OBJECTIVE This study seeks to utilize geospatial analysis to identify distinct trends in lumbar fusion incidence and techniques in Medicare populations. SUMMARY OF BACKGROUND DATA With an aging population and new technologies, lumbar fusion is an increasingly common procedure. There is controversy, however, regarding which indications and techniques achieve optimal outcomes, leading to significant intersurgeon variation and potential national disparities in care. MATERIALS AND METHODS Medicare billing datasets were supplemented with Census Bureau socioeconomic data from 2013 to 2020. These databases listed lumbar fusions billed to Medicare by location, specialty, and technique. Hotspots and coldspots of lumbar fusion incidence and technique choice were identified with county-level analysis and compared with Mann-Whitney U . A linear regression of fusion incidence and a logistic regression of lumbar fusion hotspots/coldspots were also calculated. RESULTS Between 2013 and 2020, 624,850 lumbar fusions were billed to Medicare. Lumbar fusion hotspots performed fusions at nearly five times the incidence of coldspots (101.6-21.1 fusions per 100,000 Medicare members) and were located in the Midwest, Colorado, and Virginia while coldspots were in California, Florida, Wisconsin, and the Northeast. Posterior and posterolateral fusion were the most favored techniques, with hotspots in the Northeast. Combined posterior and posterolateral fusion and posterior interbody fusion was the second most favored technique, predominantly in Illinois, Missouri, Arkansas, and Colorado. CONCLUSIONS The geographic distribution of lumbar fusions correlates with variations in residency training, fellowship, and specialty. The geospatial patterning in both utilization and technique reflects a lack of consensus in the application of lumbar fusion. The strong variance in utilization is a potentially worrying finding that could suggest that the nonstandardization of lumbar fusion indication has led to both overtreatment and undertreatment across the nation. LEVEL OF EVIDENCE Level 3-retrospective.
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Affiliation(s)
- Nicholas Peterman
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL
| | - Krishin Shivdasani
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN
| | - Eunhae Yeo
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL
| | - Joshua Simon
- Department of Neurosurgery, Loyola University Medical Center, Maywood, IL
| | - Jonathan Garst
- Department of Neurosurgery, OSF Saint Francis Medical Center, Peoria, IL
| | | | - Catherine Stauffer
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL
| | - Bradley Kaptur
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL
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Pagani NR, Grant A, Bamford M, Peterman N, Smith EL, Gordon MR. Socioeconomic Disadvantage Predicts Decreased Likelihood of Maintaining a Functional Knee Arthroplasty Following Treatment for Prosthetic Joint Infection. J Arthroplasty 2024:S0883-5403(24)00024-X. [PMID: 38220025 DOI: 10.1016/j.arth.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) carries major morbidity and mortality as well as a complicated and lengthy treatment course. In patients who have high degrees of socioeconomic disadvantage, this may be a particularly devastating complication. Our study sought to evaluate the impact of socioeconomic deprivation on outcomes following treatment for PJI of the knee. METHODS We conducted a retrospective review of revision total knee arthroplasty (TKA) procedures performed for the treatment of initial PJI between 2008 and 2020 at a single tertiary care center in the United States. The Area Deprivation Index (ADI) was used to quantify socioeconomic deprivation. The primary outcome measure was presence of a functional knee joint at the time of most recent follow-up defined as TKA components or an articulating spacer. A total of 96 patients were included for analysis. The median follow-up duration was 26.5 months. RESULTS There was no significant difference in the rate of treatment failure (P = .63). However, the proportion of patients who had a functional knee arthroplasty (in contrast to having undergone arthrodesis, amputation, or retention of a static spacer) declined significantly with increasing ADI index (81.8% for the least disadvantaged group, 58.7% for the middle group, 42.9% for the most disadvantaged group, P = .021). CONCLUSIONS Patients who have a higher socioeconomic disadvantage as measured by ADI are less likely to maintain a functional knee arthroplasty following treatment for TKA PJI. These findings support continued efforts to improve access to care and optimize treatment plans for patients who have socioeconomic disadvantage.
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Affiliation(s)
- Nicholas R Pagani
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | - Andrew Grant
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | | | - Nicholas Peterman
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Eric L Smith
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | - Matthew R Gordon
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts
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Naik A, Peterman N, Furey C, Paisan G, Catapano J, Bhardwaj D, Iyer A, Bederson M, Pappu S, Snyder L, Stroink A, Lawton MT, Arnold PM. Factors influencing geographic gender disparity in neurosurgery: a nationwide geospatial clustering analysis. J Neurosurg 2024; 140:282-290. [PMID: 37439489 DOI: 10.3171/2023.5.jns23203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Women neurosurgeons (WNs) continue to remain a minority in the specialty despite significant initiatives to increase their representation. One domain less explored is the regional distribution of WNs, facilitated by the hiring practices of neurosurgical departments across the US. In this analysis, the authors coupled the stated practice location of WNs with regional geospatial data to identify hot spots and cold spots of prevalence and examined regional predictors of increases and decreases in WNs over time. METHODS The authors examined the National Provider Identifier (NPI) numbers of all neurosurgeons obtained via the National Plan and Provider Enumeration System (NPPES), identifying the percentage of WNs in each county for which data were appended with data from the US Census Bureau. Change in WN rates was identified by calculating a regression slope for all years included (2015-2022). Hot spots and cold spots of WNs were identified through Moran's clustering analysis. Population and surgeon features were compared for hot spots and cold spots. RESULTS WNs constituted 10.73% of all currently active neurosurgical NPIs, which has increased from 2015 (8.81%). Three hot spots were found-including the Middle Atlantic and Pacific divisions-that contrasted with scattered cold spots throughout the East Central regions that included Memphis as a major city. Although relatively rapidly growing, hot spots had significant gender inequality, with a median WN percentage of 11.38% and a median of 0.61 WNs added to each respective county per year. CONCLUSIONS The authors analyzed the prevalence of WNs by using aggregated data from the NPPES and US Census Bureau. The authors also show regional hot spots of WNs and that the establishment of WNs in a region is a predictor of additional WNs entering the region. These data suggest that female neurosurgical mentorship and representation may be a major driver of acceptance and further gender diversity in a given region.
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Affiliation(s)
- Anant Naik
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois; and
| | - Nicholas Peterman
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois; and
| | - Charuta Furey
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Gabriella Paisan
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Joshua Catapano
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Drishti Bhardwaj
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois; and
| | - Ankitha Iyer
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois; and
| | - Maria Bederson
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois; and
| | - Suguna Pappu
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois; and
| | - Laura Snyder
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Ann Stroink
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois; and
| | - Michael T Lawton
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Paul M Arnold
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois; and
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Peterman N, Shivdasani K, Naik A, Dharnipragada R, Harrop J, Vaccaro AR, Arnold PM. Geospatial Evaluation of Disparities in Access to Cervical Spine Fusion in Metropolitan Areas Across the United States. Clin Spine Surg 2023:01933606-990000000-00244. [PMID: 38158598 DOI: 10.1097/bsd.0000000000001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN Retrospective study with epidemiologic analysis of public Medicare data. OBJECTIVE The purpose of this study is to use geospatial analysis to identify disparities in access to cervical spine fusions in metropolitan Medicare populations. SUMMARY OF BACKGROUND DATA Cervical spine fusion is among the most common elective procedures performed by spine surgeons and is the most common surgical intervention for degenerative cervical spine disease. Although some studies have examined demographic and socioeconomic trends in cervical spine fusion, few have attempted to identify where disparities exist and quantify them at a community level. METHODS Center for Medicare and Medicaid Services physician billing and Medicare demographic data sets from 2013 to 2020 were filtered to contain only cervical spine fusion procedures and then combined with US Census socioeconomic data. The Moran Index geospatial clustering algorithm was used to identify statistically significant hotspot and coldspots of cervical spine fusions per 100,000 Medicare members at a county level. Univariate and multivariate analysis was subsequently conducted to identify demographic and socioeconomic factors that are associated with access to care. RESULTS A total of 285,405 cervical spine fusions were analyzed. Hotspots of cervical spine fusion were located in the South, while coldspots were throughout the Northern Midwest, the Northeast, South Florida, and West Coast. The percent of Medicare patients that were Black was the largest negative predictor of cervical spine fusions per 100,000 Medicare members (β=-0.13, 95% CI: -0.16, -0.10). CONCLUSIONS Barriers to access can have significant impacts on health outcomes, and these impacts can be disproportionately felt by marginalized groups. Accounting for socioeconomic disadvantage and geography, this analysis found the Black race to be a significant negative predictor of access to cervical spine fusions. Future studies are needed to further explore potential socioeconomic barriers that exist in access to specialized surgical care. LEVEL OF EVIDENCE Level III-retrospective.
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Affiliation(s)
- Nicholas Peterman
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
| | - Krishin Shivdasani
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
- Department of Orthopaedic Surgery & Rehabilitation, Loyola Medicine, Maywood IL
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis MN
| | - Rajiv Dharnipragada
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis MN
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson Hospital
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Orthopedic Institute, Philadelphia PA
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
- Department of Neurosurgery, Carle Foundation Hospital, Urbana IL
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Sharma AN, Peterman N, Juhasz M, Shive M. MMS hotspots: a cross-sectional comparison of U.S. counties with and without Mohs micrographic surgery. Arch Dermatol Res 2023; 316:21. [PMID: 38060044 PMCID: PMC10703960 DOI: 10.1007/s00403-023-02751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/17/2023] [Accepted: 10/18/2023] [Indexed: 12/08/2023]
Abstract
Healthcare access greatly impacts skin cancer diagnosis and mortality rates. Recognition of current disparities in Mohs micrographic surgery (MMS) access can assist future policy and clinical decisions to correct them. For the years 2014-2018, the CPT codes for MMS (17,311 and 17,313) were counted on a per county level across the United States per the Medicare Centers for Medicare & Medicaid Services (CMS) Medicare Prescriber Database. Any county with 0 MMS CPT codes recorded were classified as "without MMS cases." MMS "hotspots" were identified as counties that possessed a high average number of MMS cases compared to the national average, while also being surrounded by counties that possessed a low average number of MMS cases compared to the national average. Three thousand eighty-four counties in the United States were analyzed; 785 (25%) counties were designated as "with MMS cases" and 2301 (75%) "without MMS cases." There were no significant differences in age, ethnicity distribution, or cost per enrollee between the two designations. 74% of counties with MMS cases were considered urban, while only 25% of those without cases were urban (p < 0.01). The median household income was markedly higher in counties with MMS cases ($71,428 vs. $58,913, p < 0.01). With respect to education, more individuals in counties with MMS cases possessed their General Education Development (GED) (89% vs. 86%, p < 0.01) or a college degree (30% vs. 19%, p < 0.01). Forty-nine counties were considered MMS "hotspots." The density of MMS procedures varies greatly based on geography, maintaining the urban-rural disparity matched by the distribution of MMS surgeons. Additionally, there remains a wide income and educational gap between counties with and without MMS. Identifying MMS hotspots may facilitate further investigation into potential surgical access disparities.
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Affiliation(s)
- Ajay Nair Sharma
- Department of Dermatology, University of California, Irvine, 118 Med Surg I, Irvine, CA, 92697, USA
| | - Nicholas Peterman
- Carle College of Medicine, University of Illinois, Urbana-Champaign, USA
| | - Margit Juhasz
- Department of Dermatology, University of California, Irvine, 118 Med Surg I, Irvine, CA, 92697, USA
| | - Melissa Shive
- Department of Dermatology, University of California, Irvine, 118 Med Surg I, Irvine, CA, 92697, USA.
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Beck JH, Sandefur EP, Vest MO, Yu-Shan AA, Peterman N, Apel PJ. Changes in Management at the Postoperative Visit After In-Office Wide Awake Local Anesthetic No Tourniquet Carpal Tunnel Release. J Hand Surg Am 2023:S0363-5023(23)00550-6. [PMID: 38010235 DOI: 10.1016/j.jhsa.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Patients are commonly seen for two postoperative visits following carpal tunnel release (CTR), the first visit being at 1-2 weeks and the second at approximately 6 weeks. Our study aimed to determine if these visits led to changes in postoperative medical management. METHODS A retrospective review was conducted of 748 procedures performed in an in-office procedure room under wide awake local anesthetic no tourniquet between August 2020 and December 2022. Charts were reviewed for changes in management related to the patient's CTR. Management changes involving a separate diagnosis or solely an additional follow-up visit were classified as unrelated to postoperative CTR care. RESULTS A total of 730 patients returned for follow-up. There were 100 patients (13.7 %) who had a CTR-related change in management at the first postoperative visit. Most management changes at this timepoint were due to superficial surgical site infection. There were 29 patients (4.0 %) who had a CTR-related change in management at their second postoperative visit, most commonly a referral to therapy for stiffness or hypersensitivity. CONCLUSIONS While postoperative visits for CTR may have intangible benefits, changes in CTR-related care occur only in 17.7% of patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jadon H Beck
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Roanoke, Virginia, United States of America
| | - Evan P Sandefur
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Maxwell O Vest
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Roanoke, Virginia, United States of America; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Andrea A Yu-Shan
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Roanoke, Virginia, United States of America
| | - Nicholas Peterman
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Roanoke, Virginia, United States of America
| | - Peter J Apel
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Roanoke, Virginia, United States of America; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America.
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Nyaeme M, Yerrabelli RS, Peterman N, Kaptur B, Yeo E, Carpenter KR. Geospatial Distribution of Ambulatory Surgery Center Utilization for Otorhinolaryngologic Surgeries Among Medicare Patients From 2015 to 2019. OTO Open 2023; 7:e57. [PMID: 37305100 PMCID: PMC10249421 DOI: 10.1002/oto2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/18/2023] [Accepted: 04/06/2023] [Indexed: 06/13/2023] Open
Abstract
Objective To investigate the geographic clustering of ambulatory surgical center (ASC) utilization in otolaryngology to determine hot spot areas of high utilization and cold spot areas of low utilization and socioeconomic factors that correlate with these hot spots and cold spots. Study Design To develop a national epidemiologic study of ASC utilization in otolaryngology in the United States. Setting United States of America. Methods Multiple county-level national databases were reviewed including Center for Medicare Services (CMS) physician billing data, CMS Medicare demographic data, and US Census socioeconomic data. The analysis was conducted using the average of all Medicare billing information from 2015 to 2019. Whether a procedure was performed in an ASC was extracted from CMS data using the CMS definition of an ASC. The percentage ASC billing was calculated as the fraction of CMS payments that were performed in ASCs for the top ENT procedures. A Python-based script for database building and GeoDa, Moran's I clustering coefficient, and a 1-way analysis of variance was utilized to chart and analyze demographic, geographic, and socioeconomic trends. Results Hot spots of utilization, with an average ASC billing of 80.13%, were seen in Southern California, Florida, Mid-Atlantic, and clusters throughout the Deep South. Cold spot clusters, with an average ASC billing of 2.21%, were located in large swaths of New England, Ohio, and the Deep South with clusters bisecting the Midwest. Cold spots had a higher percentage of poverty and percent eligible for Medicaid. Conclusion ASC utilization is best used to improve cost-effectiveness and accessibility of care but what is seen is that ASC use is currently highest in cities in coastal areas which already have high levels of care access and are making the most proportional money compared to their rural counterparts.
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Affiliation(s)
- Mark Nyaeme
- Carle Illinois College of MedicineUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
- Carle Foundation HospitalUrbanaIllinoisUSA
| | - Rahul S. Yerrabelli
- Carle Illinois College of MedicineUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
- Carle Foundation HospitalUrbanaIllinoisUSA
| | - Nicholas Peterman
- Carle Illinois College of MedicineUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
- Carle Foundation HospitalUrbanaIllinoisUSA
| | | | - Eunhae Yeo
- Carle Foundation HospitalUrbanaIllinoisUSA
| | - Kristine R. Carpenter
- Carle Illinois College of MedicineUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
- Carle Foundation HospitalUrbanaIllinoisUSA
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11
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Lee C, Lowe J, Peterman N, Kaptur B, Yeo E, Carpenter K. PSUN303 Nationwide Geospatial Analysis of Hospitalization in Diabetes Mellitus Complications. J Endocr Soc 2022. [PMCID: PMC9625758 DOI: 10.1210/jendso/bvac150.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Diabetes mellitus and complications associated with the disease represent a significant source of morbidity within the United States. Substantial public health efforts have been devoted to understanding the factors that underlie poor outcomes in diabetes. The purpose of this work is to (1) determine whether there exist statistically significant geospatial disparities in the relative rate of diabetic complications in Medicare patients throughout the United States, and (2) if these exist, assess the socioeconomic, cultural, and medical attributes that distinguish communities delineated by these variations. This work utilized multiple public databases, including National Plan and Provider Enumeration System (NPPES), US Department of Agriculture (USDA), US Census, and Center for Medicare Services (CMS) data. Datasets were combined on a county level to quantify 18 socioeconomic, 22 health, and 4 diabetic management attributes of 3061 total counties in the contiguous United States. CMS Prevention Quality Indicators (PQI) #1 (Diabetes Short-Term Complications Admission Rate), #3 (Diabetes Long-Term Complications Admission Rate), and #16 (Lower-Extremity Amputation Among Patients with Diabetes Rate) were used as the main indicators of county-level diabetic control, along with the total number of practicing endocrinologists. These variables were scaled to the number of Medicare members with diabetes in each county. All variables were for the latest available year, 2019, with the exception of the number of practicing endocrinologists (from December 2021). The synthesized database was then exported to GeoDa, a geospatial analysis program, where statistically significant (p < 0.05) diabetes complication spatial hotspots, coldspots, and outliers were identified using Moran's I on a national level. ANOVA was then conducted across all Moran's I groupings with a two-tailed t-test between hotspot and coldspot groupings to identify what socioeconomic, health, and diabetic management attributes were statistically significant between complication geostructures. Geospatial visualization revealed an expansive hotspot cluster in the normalized diabetes long-term complication admission rate that encompassed the East Coast and included portions of Florida and Texas (p < 0.05). Conversely, an expansive coldspot cluster encompassed much of the West and Great Plains region. Similar geospatial patterns were observed in the short-term complication admission rate, with the caveat of a new hotspot cluster that encompassed California and the West Coast (p < 0.05). ANOVA using the identified clusters as groupings revealed differences between hotspot and coldspot clusters: Hotspots tended to have greater Hispanic (6.7% to 1.8%) and Black (10.9% to 0.6%) representation compared to coldspots. They tended to have greater population density (2877 to 124 persons/sq. mile). Hotspots also tended to have more endocrinologists per capita (3.0 to 0.87) than coldspots. Variables of interest that did not appear to differ included the percent in poverty and the percent uninsured. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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12
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Peterman N, Smith EJ, Liang E, Yeo E, Kaptur B, Naik A, Arnold PM, Hassaneen W. Geospatial evaluation of disparities in neurosurgical access in the United States. J Clin Neurosci 2022; 105:109-114. [PMID: 36148727 DOI: 10.1016/j.jocn.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/15/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022]
Abstract
When neurosurgical care is needed, the distance to a facility staffed with a neurosurgeon is critical. This work utilizes geospatial analysis to analyze access to neurosurgery in the Medicare population and relevant socioeconomic factors. Medicare billing and demographic data from 2015 to 2019 were combined with national National Provider Identifier (NPI) registry data to identify the average travel distance to reach a neurosurgeon as well as the number of neurosurgeons in each county. This was merged with U.S. Census data to capture 23 socioeconomic attributes. Moran's I statistic was calculated across counties. Socioeconomic variables were compared using ANOVA. Hotspots with the highest neurosurgeon access were predominantly located in the Mid-Atlantic region, central Texas, and southern Montana. Coldspots were found in the Great Plains, Midwest, and Southern Texas. There were statistically significant differences (p < 0.05) between high- and low-access counties, including: stroke prevalence, poverty, median household income, and total population density. There were no statistically significant differences in most races or ethnicities. Overall, there exist statistically significant clusters of decreased neurosurgery access within the United States, with varying sociodemographic characteristics between access hotspots and coldspots.
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Affiliation(s)
| | | | - Edward Liang
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Eunhae Yeo
- Carle Illinois College of Medicine, Urbana, IL, USA
| | | | - Anant Naik
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Paul M Arnold
- Carle Illinois College of Medicine, Urbana, IL, USA; Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA
| | - Wael Hassaneen
- Carle Illinois College of Medicine, Urbana, IL, USA; Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA.
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13
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Kaptur B, Peterman N, Lee J. Nutraceuticals and dietary supplements: Disparities in usage and potential for harm. Nutr Health 2022; 28:325-330. [PMID: 35521933 DOI: 10.1177/02601060221099690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: The use of nutraceuticals and dietary supplements has a complex history. Aim: This work seeks to discuss the current state of nutraceuticals and dietary supplements, with a particular focus on the ambiguity of these terms, their current usage, potential harms, roles within the healthcare system, and associated disparities. Methods: This work reviews recent literature spanning the history of nutraceuticals and expands upon recommendations made by previous authors. Results: While a substantial portion of the United States population consumes these substances, their safety profiles are rarely well characterized. Taking a broad definition of these terms paints a picture of harmless use by a population that is middle-aged, educated, and white. However, focusing on specific substances reveals concerning disparities in race, ethnicity, income, physical health, and health literacy. This is of particular concern when looking at the side effects of these supplements both in isolation and due to drug-supplement interactions. Conclusions: In this work, the authors build upon the recommendations of others to propose ways in which physicians and healthcare systems can work to reduce the disproportionate harms of these substances on historically marginalized groups.
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Affiliation(s)
- Bradley Kaptur
- Carle Illinois College of Medicine, 573544University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Nicholas Peterman
- Carle Illinois College of Medicine, 573544University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Jan Lee
- Carle Illinois College of Medicine, 573544University of Illinois at Urbana-Champaign, Champaign, IL, USA
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14
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Yerrabelli RS, Peterman N, Kaptur B, Yeo E, Carpenter K. Geospatial distribution of relative cesarean section rates within the USA. BMC Res Notes 2022; 15:247. [PMID: 35841059 PMCID: PMC9284873 DOI: 10.1186/s13104-022-06141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the existence of statistically significant clusters of Cesarean section rates at the county level and assess the relationship of such clusters with previously implicated socioeconomic factors. Results County-level obstetrics data was extracted from March of Dimes, originally sourced from National Center for Health Statistics. County-level demographic data were extracted from the US Census Bureau. Access to obstetricians was extracted from National Provider Identifier records. Rural counties were identified using Rural Urban Commuting Area codes developed by the department of agriculture. The dataset was geospatially analyzed using Moran’s I statistic, a metric of local spatial autocorrelation, to identify clusters of increased or decreased Cesarean section rates. The American South, especially the Deep South, is a major cluster of increased Cesarean section rates. As a general but not absolute pattern, the American West and Midwest had lower Cesarean section rates than the Northeast. Focal areas of increased Cesarean section rates included the Kansas-Nebraska border, Michigan’s upper peninsula, and the New York City metropolitan area. The gross geospatial differences were not explained by rurality, obstetric access, or ethnic and racial factors alone. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06141-w.
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Affiliation(s)
- Rahul S Yerrabelli
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, llinois, 61820, USA.,Carle Foundation Hospital, Urbana, IL, 61801, USA
| | - Nicholas Peterman
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, llinois, 61820, USA.,Carle Foundation Hospital, Urbana, IL, 61801, USA
| | - Bradley Kaptur
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, llinois, 61820, USA. .,Carle Foundation Hospital, Urbana, IL, 61801, USA.
| | - Eunhae Yeo
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, llinois, 61820, USA.,Carle Foundation Hospital, Urbana, IL, 61801, USA
| | - Kristine Carpenter
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, llinois, 61820, USA.,Carle Foundation Hospital, Urbana, IL, 61801, USA
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15
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Alali SA, Peterman N, Brown CS, Bensimhon D, Carnell J, Riordan J, Cordial P, Neuenschwander J, Patel J, Imhoff B, Peacock WF. Abstracts for the 40 th Emergencies in Medicine Conference. J Emerg Trauma Shock 2022. [PMCID: PMC9838651 DOI: 10.4103/jets.jets_106_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Affiliation(s)
- Sukaina Ali Alali
- Internal Medicine Department, Central Michigan University, MI, USA,Address for correspondence: Dr. Sukaina Ali Alali, 1000 Houghton Avenue, Saginaw, MI 48602, USA. E-mail:
| | - Nicholas Peterman
- Medical Student, Carle Illinois College of Medicine, University of Illinois, Urbana-Champaign, Urbana, IL, USA
| | | | | | - Jennifer Carnell
- Department of Clinical Pharmacy and Outcomes Sciences, Baylor College of Medicine, Houston, TX, USA
| | - John Riordan
- Emergency Department, University of Virginia Health System, Charlottesville, VA, USA
| | - Parker Cordial
- The Ohio State University College of Medicine, OH, Texas, USA
| | - James Neuenschwander
- Department of Emergency Medicine, Genesis Healthcare System, Zanesville, Ohio, USA
| | - Janak Patel
- The University of Kansas Medical Center Kansas City, KS, USA
| | - Bryan Imhoff
- The University of Kansas Medical Center Kansas City, KS, USA
| | - William Frank Peacock
- Department of Clinical Pharmacy and Outcomes Sciences, Baylor College of Medicine, Houston, TX, USA
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Nikitina A, Huang D, Li L, Peterman N, Cleavenger SE, Fernández FM, Kemp ML. A Co-registration Pipeline for Multimodal MALDI and Confocal Imaging Analysis of Stem Cell Colonies. J Am Soc Mass Spectrom 2020; 31:986-989. [PMID: 32176489 PMCID: PMC7370321 DOI: 10.1021/jasms.9b00094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Multimodal mass spectrometry imaging (MSI) data presents unique big data challenges in handling and analysis. Here, we present a pipeline for co-registering matrix-assisted laser desorption/ionization MSI and confocal immunofluorescence imaging data for extracting single-cell metabolite signatures. We further describe methods and introduce software for the simultaneous analysis of these concatenated data sets, which are designed to establish a connection between cell traits of interest (shape metrics, position within sample) and the cells' own metabolic signatures.
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Affiliation(s)
- Arina Nikitina
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Danning Huang
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Li Li
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Nicholas Peterman
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia 30332, United States
| | - Sarah E Cleavenger
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia 30332, United States
| | - Facundo M Fernández
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
- Petit Institute of Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Melissa L Kemp
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia 30332, United States
- Petit Institute of Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
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Lambert N, Robertson A, Srivas R, Peterman N, Close J, Wilson T, George P, Wood H, Wong B, Tezcan A, Tezcan H. Comparison of enzymatic-and bisulfite conversion to map the plasma cell-free methylome in cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz238.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Davis A, Iams W, Chan D, Oh M, Lentz R, Peterman N, Robertson A, Shah A, Srivas R, Lambert N, Wilson T, George P, Wong B, Close J, Wood H, Tezcan A, Spinosa J, Tezcan H, Chae Y. Dynamic changes in whole-genome cell-free DNA (cfDNA) to identify disease progression prior to imaging in advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Davis A, Iams W, Chan D, Oh M, Lentz R, Srivas R, Lambert N, Robertson A, Peterman N, Shah A, Wilson T, Close J, George P, Wood H, Wong B, Tezcan A, Spinosa J, Tezcan H, Chae Y. Longitudinal changes in cell-free DNA (cfDNA) methylation levels identify early non-responders to treatment in advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Davis A, Iams W, Chan D, Oh M, Lentz R, Peterman N, Robertson A, Shah A, Srivas R, Lambert N, Wilson T, Tezcan A, Spinosa J, Tezcan H, Mohindra N, Villaflor V, Chae Y. P1.01-49 Serial Changes in Whole-Genome Cell-Free DNA (cfDNA) to Identify Disease Progression Prior to Imaging in Advanced NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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