Differences In Access Research Articles

Effect of temperature and pH on the structure and stability of tumor-specific lectin jacalin and insights into the location of its tryptophan residues: CD, DSC and fluorescence studies

Jacalin, the jackfruit seed lectin, exhibits high specificity for the tumor-specific T-antigen and is used in various biomedical and biotechnological applications. Here, we report biophysical studies on the thermal unfolding of jacalin and the effect of pH and temperature on its secondary structure. Differential scanning calorimetric (DSC) studies revealed that native jacalin unfolds at ∼60 °C and that carbohydrate binding stabilizes the protein structure. Circular dichroism spectroscopic studies indicated that the secondary structure of jacalin remains mostly unaffected over pH 2.0–9.0, whereas considerable changes were observed in the tertiary structure. DSC experiments demonstrated that jacalin exhibits two overlapping transitions between pH 2 and 5, which could be attributed to dissociation of the tetrameric protein into subunits and their unfolding. Interestingly, only one transition between pH 6 and 9 was observed, suggesting that the subunit dissociation and unfolding occur simultaneously. While quenching of the protein intrinsic fluorescence by acrylamide increased significantly upon carbohydrate binding, quenching by succinimide is essentially unaffected. We attribute this difference to increased exposure of Trp-123 in the α-chain as it is involved in carbohydrate binding. Both acrylamide and succinimide gave biphasic Stern-Volmer plots, consistent with differential accessibility of the two tryptophan residues of jacalin to them.

The role of breastfeeding support in racial/ethnic disparities in breastfeeding practices

BackgroundPersistent racial/ethnic disparities in breastfeeding practices in the United States are well documented but the underlying causes remain unclear. While racial/ethnic disparities are often intertwined with socioeconomic disparities in breastfeeding, studies suggest that lack of breastfeeding support from family, health care organizations and workplaces may contribute to racial/ethnic disparities in breastfeeding rates. No studies have investigated the extent to which racial/ethnic disparities in breastfeeding practices can be explained by breastfeeding support. MethodsWe used survey data from participants of a federal nutrition assistance program in Los Angeles County, the most populous county in the United States, to examine causal mechanisms underlying racial/ethnic disparities in breastfeeding in five groups: Spanish-speaking Latina, English-speaking Latina, Non-Hispanic White (NHW), Non-Hispanic Black (NHB) and Non-Hispanic Asian (NHA). Applying causal mediation analysis, this study estimated the proportion of racial/ethnic differences in breastfeeding (‘any’ breastfeeding, i.e., partial or exclusive) rates at 6 months that could be explained by differential access to breastfeeding support from family, birth hospitals and workplaces. ResultsNHB and English-speaking Latina mothers were less likely, and Spanish-speaking Latina mothers more likely to breastfeed through 6 months than NHW mothers. Lack of breastfeeding support from family, hospitals and workplaces accounted for approximately 68% of the difference in any breastfeeding rates at 6 months between NHW and NHB mothers and 36% of the difference between NHW and English-speaking Latina mothers. ConclusionThese findings highlight the importance of improving support from family, hospitals and workplaces for breastfeeding mothers to reduce racial/ethnic disparities in breastfeeding.

Chromatin accessibility and epigenetic deoxyribose nucleic acid (DNA) modifications in chronic kidney disease (CKD) osteoblasts: a study of bone and osteoblasts from pediatric patients with CKD.

Maturation defects are intrinsic features of osteoblast lineage cells in CKD patients. These defects persist ex vivo, suggesting that CKD induces epigenetic changes in bone cells. To gain insights into which signaling pathways contribute to CKD-mediated, epigenetically driven, impairments in osteoblast maturation, we characterized RNA expression and DNA methylation patterns by RNA-Seq and MethylationEpic in primary osteoblasts from nine adolescent and young adult dialysis patients with end-stage kidney disease and three healthy references. ATAC-Seq was also performed on a subset of osteoblasts. Bone matrix protein expression was extracted from the iliac crest and evaluated by proteomics. Gene set enrichment analysis was used to establish signaling pathways consistently altered in chromatin accessibility, DNA methylation, and RNA expression patterns. Single genes were suppressed in primary osteoblasts using shRNA and mineralization characterized in vitro. The effect of nuclear factor of activated T cells (NFAT) signaling suppression was also assessed using 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) incorporation. We found that signaling pathways critical for osteoblast differentiation were strongly downregulated in CKD osteoblasts. Gene set enrichment analysis identified highly significant methylation changes, differential chromatin accessibility, and altered RNA expression in NFAT signaling targets. NFAT inhibition reduced osteoblast proliferation. Combined analysis of osteoblast RNA expression and whole bone matrix composition identified 13 potential ligand-receptor pairs. In summary, epigenetic changes in CKD osteoblasts associate with altered expression of multiple osteoblast genes and signaling pathways. An increase in NFAT signaling may play a role in impaired CKD osteoblast maturation. Epigenetic changes also associate with an altered bone matrix, which may contribute to bone fragility. Further studies are necessary to elucidate the pathways affected by these genetic alterations since elucidating these pathways will be vital to correcting the underlying biology of bone disease in the CKD population.

THE EPIGENETIC LANDSCAPE IN SOFT-TISSUE FIBROSIS

Dupuytren's disease (DD) is a fibroproliferative soft tissue disease affecting the palmar fascia of the hand causing permanent and irreversible flexion contracture. Aberrant fibrosis is likely to manifest through a combination of extrinsic, intrinsic, and environmental factors, including genetics and epigenetics. However, the role of epigenetics in soft tissue fibrosis in diseases such as DD is not well established. Therefore, we conducted a comprehensive multi-omic study investigating the epigenetic profiles that influence gene expression in DD pathology. Using control (patients undergoing carpal tunnel release) and diseased fibroblasts (patients undergoing Dupuytren's fasciectomy), we conducted ATAC-seq to assess differential chromatin accessibility between control and diseased fibroblasts. Additionally, ChIP-seq mapped common histone modifications (histone H4; H3K4me3, H3K9me3, H3K27me3, H4K16Ac, H4K20Me3) associated with fibrosis. Furthermore, we extracted RNA from control and DD tissue and performed bulk RNA-seq.ATAC-seq analysis identified 2470 accessible genomic loci significantly more accessible in diseased fibroblasts compared to control. Comparison between diseased and control cells identified numerous significantly different peaks in histone modifications (H4K20me3, H3K27me3, H3K9me3) associated with gene repression in control cells but not in diseased cells. Pathway analysis demonstrated a substantial overlap in genes being de-repressed across these histone modifications (Figure 1). Both, ATAC-seq and ChIP-seq analysis indicated pathways such as cell adhesion, differentiation, and extracellular matrix organisation were dysregulated as a result of epigenetic changes. Moreover, de novo motif enrichment analysis identified transcription factors that possibly contributed to the differential gene expression between control and diseased tissue, including HIC1, NFATC1 and TEAD2. RNA-seq analysis found that these transcription factors were upregulated in DD tissue compared to control tissue.The current epigenetic study provides insights into the aberrant fibrotic processes associated with soft tissue diseases such as DD and indicates that epigenetic-targeted therapies may be an interesting viable treatment option in future.For any figures or tables, please contact the authors directly.

Double Differential Modulation-Based Non-Orthogonal Multiple Access

Double Differential Modulation-Based Non-Orthogonal Multiple Access

Combined ATAC-seq, RNA-seq, and GWAS analysis reveals glycogen metabolism regulatory network in Jinjiang oyster ( Crassostrea ariakensis).

Glycogen serves as the principal energy reserve for metabolic processes in aquatic shellfish and substantially contributes to the flavor and quality of oysters. The Jinjiang oyster ( Crassostrea ariakensis) is an economically and ecologically important species in China. In the present study, RNA sequencing (RNA-seq) and assay for transposase-accessible chromatin using sequencing (ATAC-seq) were performed to investigate gene expression and chromatin accessibility variations in oysters with different glycogen contents. Analysis identified 9 483 differentially expressed genes (DEGs) and 7 215 genes with significantly differential chromatin accessibility (DCAGs) were obtained, with an overlap of 2 600 genes between them. Notably, a significant proportion of these genes were enriched in pathways related to glycogen metabolism, including "Glycogen metabolic process" and "Starch and sucrose metabolism". In addition, genome-wide association study (GWAS) identified 526 single nucleotide polymorphism (SNP) loci associated with glycogen content. These loci corresponded to 241 genes, 63 of which were categorized as both DEGs and DCAGs. This study enriches basic research data and provides insights into the molecular mechanisms underlying the regulation of glycogen metabolism in C. ariakensis.

The evolution of health system planning and implementation of maternal telehealth services during the COVID-19 Pandemic.

Differential access to healthcare is associated with disparities in maternal outcomes. Telehealth is one approach for improving access to maternal services. However, little is known regarding how health systems leverage telehealth to close the access gap. This study examines how health systems have approached decisions about using telehealth for maternal services before and during the COVID-19 public health emergency and what factors were considered. We conducted semi-structured interviews with 15 health system leaders between July and October 2021 and June and August 2022. We used a rapid analysis followed by a content analysis approach. Five health systems did not provide maternal telehealth services before the PHE due to a lack of reimbursement. Two health systems provided limited services as research endeavors, and one had integrated telehealth into routine maternity care. During the PHE, all transitioned to telehealth, with the primary consideration being patient and staff safety. At the time of the interview, key considerations shifted to patient access, patient preferences, patient complexity, return on investment, and staff burnout. However, several barriers impacted telehealth use, including coverage of portable devices and connectivity. These issues were reported to be common among underinsured, low-income, and rural patients. Health systems with particularly advanced capabilities worked on approaches to fill access gaps for these patients. Some health systems prioritized telehealth to improve access to high-quality maternal services for patients at the highest risk of adverse outcomes. However, policy and patient-level barriers to equitable implementation of these services persist.

The politics of commerce in eighteenth-century Bengal: A reappraisal

This article broaches a simple question: Was there a politics of commerce within Bengali society in the eighteenth century, or was such politics limited to disputes between the British East India Company (EIC) and the Bengal nawabs? I begin by discussing the literature on markets in eighteenth-century Bengal and argue that the relationship between commerce and politics has been too narrowly defined in this body of work. A one-sided focus on determining the impact of the early colonial state, coupled with an uncritical acceptance of Peter Marshall’s Namierite story about the origins of the British empire, has led historians to downplay ideological conflicts within the EIC and British society. To show why these divisions matter, I build on the recent work of James Vaughn and Spencer Leonard, who have shown that between 1750 and 1770, political and ideological conflicts in both Britain and Bengal had far-reaching effects on the character of the British empire. Through an extended discussion of a dispute over market access in 1778 in the city of Calcutta, I show that petty merchants and shopkeepers often opposed arbitrary impositions by regional elites. To fully understand the motivations behind such challenges, I argue that we need to seriously consider divisions within Bengali society as well: namely, the reproduction of caste hierarchies through differential access to markets (and land).

Variations in COPD Health Care Access and Outcomes: A Rapid Review.

Health inequities among individuals with chronic obstructive pulmonary disease (COPD) are often associated with differential access to health care and health outcomes. A greater understanding of the literature concerning such variation is necessary to determine where gaps or inequities exist along the continuum of COPD care. A rapid review of the published and grey literature reporting variations in health care access and/or health outcomes for individuals with COPD was completed. Variation was defined as differential patterns in access indicators or outcome measures within sociodemographic categories, including age, ethnicity, geography, race, sex, and socioeconomic status. Emergent themes were identified from the included literature and synthesized narratively. Thirty-five articles were included for final review; the majority were retrospective cohort studies. Twenty-five studies assessed variation in access to health care. Key indicators included: access to spirometry testing, medication adherence, participation in pulmonary rehabilitation, and contact with general practitioners and/or respiratory specialists. Twenty-one studies assessed variation in health outcomes in COPD and key metrics included: hospital-based resource utilization (length of stay and admissions/readmissions), COPD exacerbations, and mortality. Patients who live in rural environments and those of lower socioeconomic status had both poorer access to care and outcomes at the system and patient level. Other sociodemographic variables, including ethnicity, race, age, and sex were associated with variation in health care access and outcomes, although these findings were less consistent. The results of this rapid review suggest that substantial variation in access and outcomes exists for individuals with COPD, highlighting opportunities for targeted interventions and policies.

It’s About Time, Part II: Does Time Poverty Contribute to Inequitable College Outcomes by Gender and Race/Ethnicity?

Existing research demonstrates gender- and race/ethnicity-based inequities in college outcomes. Separately, recent research suggests a relationship between time poverty and college outcomes for student parents and online students. However, to date, no studies have empirically explored whether differential access to time as a resource for college may explain differential outcomes by gender or race/ethnicity. To address this, this study explored the relationship between time poverty, gender or race/ethnicity, and college outcomes at a large urban public university with two and four year campuses. Time poverty explained a significant proportion of differential outcomes (retention and credit accumulation) by gender and race/ethnicity. More time-poor groups also dedicated a larger proportion of their (relatively limited) discretionary time to their education, suggesting that inequitable distributions of time may contribute to other negative outcomes (e.g., reduced time for sleep, exercise, healthcare). This suggests that time poverty is a significant but understudied equity issue in higher education.

Understanding the characteristics of the household energy transition in a developing country

Understanding the energy transition process in developing countries is crucial to implement policies to reduce the use of traditional fossil fuel-based energy sources, which increase pollution, worsen global climate change, and negatively impact people's health. Existing literature indicates that households account for approximately 25% of total energy consumption for consumption and production activities. However, understanding the energy consumption patterns of choices of energy sources and their determinants has largely been neglected in the existing literature. As such, this study uses the multivariate probit model to identify the factors influencing household energy choices in Vietnam, using data from 2016 to 2020 from the Vietnamese Households Living Standard Surveys (VHLSS). Our study focuses on how households' multiple occupations, particularly in rural areas, affect energy sources choices. We find that households participate in different agricultural sub-sectors simultaneously, resulting in differential access to multiple energy sources. Households engaging in cultivation, forestry, and animal husbandry activities are more likely to choose coal, fuelwood, and biomass as the primary energy sources for production and daily uses. In contrast, higher household income and household head with higher education level also increases the likelihood of choosing cleaner energy choices for daily uses and production activities. In addition, our empirical findings confirm the validity of the "energy stacking” hypothesis rather than the “energy ladders" hypothesis – two contrasting hypotheses concerning household energy transition in the literature. Policy implications have emerged based on the findings of this paper to enhance the clean energy transition in Vietnam in achieving sustainable economic development and social transformation and her commitment to combating global climate change issues.

Racial and ethnic disparities in premature births among pregnant women in the NISAMI cohort, Brazil.

The incidence of premature birth has increased worldwide, unequally distributed by race/ethnicity. Racism generates economic inequalities, educational disparities, and differential access to health care, which increases the risk of preterm birth. Thus, this study aimed to evaluate the factors associated with preterm birth and racial and ethnic disparities in premature birth among pregnant women attending prenatal care at the Brazilian Unified Health System health units in the urban area of Santo Antônio de Jesus, Bahia, Brazil. This study used data from 938 pregnant women aged between 18 to 45 years within the NISAMI prospective cohort. Premature birth prevalence was 11.8%, with a higher prevalence among black than non-black women (12.9% versus 6.0%, respectively). Maternal age between 18 and 24 years was the only factor associated with premature birth. A higher risk of premature birth was found among black women than non-black women (RR 3.22; 95%CI 1.42-7.32). These results reveal the existence of racial and social inequalities in the occurrence of premature birth.

Exploring the employment experiences of young adults with multiple minoritized identities: A qualitative study focusing on race and non-apparent disabilities.

Youth with disabilities often encounter many challenges in securing employment. Although the common barriers that youth face are well documented, little is known about the experiences of youth who have multiple minoritized identities in finding and maintaining employment. Youth with disabilities who belong to racial minoritized groups may encounter ableism and racism and other forms of discrimination at work. Exploring the experiences of racial minoritized youth with non-apparent disabilities is important given the growing concern about social inequities that are linked to disadvantage and differential access to resources such as employment. We used a qualitative design involving semi-structured interviews with 19 youth (13 women, 3 non-binary, 3 men), aged 17-30 (mean 23.5 years). An inductive thematic analysis was applied to analyze the data. We identified the following themes: (1) challenges finding and maintaining employment; (2) the extent of safety and comfort with disclosing minoritized identities in the workplace (i.e., comfortable disclosing; uncomfortable disclosing; did not need to disclose and/or hiding identities); (3) workplace discrimination based on minoritized identities (i.e., ableism, racism, ableist racism, gendered ableism, racist and gendered ableism); (4) impact of discrimination (i.e., negative affective outcomes, social and work adjustment, impact on professional development) and coping strategies (i.e., advocacy, networking, peer support); and (5) advice for youth and employers. Our study highlights the extent of racism and ableism that racial minoritized youth with non-apparent disabilities experience in the workplace and the importance of rehabilitation clinicians supporting their inclusion.

Kentsel Hindistan’da Kabile Yaşlıları: Kuşaklar Arası İlişkiler Üzerine Bir Çalışma

There are no other age groups increasing rapidly than elderly, which is projected to be doubled by 2050. Such demographic transition is witnessed in many developing countries including India. It is also indicated that the elderly population including the tribal elderly are increasingly dwelling in urban areas due to migration or their native areas becoming urbanized. The purpose of this research is to understand the intergenerational relationship among tribal societies dwelling in urban areas. This paper argues that elderly as like other age groups, do not constitute a single homogeneous category while marking the shift from single dimension paradigm of studying aged individual to multi-level approach i.e. ‘urban-elderly-tribes’, in understanding the intergenerational relationships. In total six Focus Group Discussions (FGDs), with fifty elderly tribes (aged 60 – 82 years) comprising of three FGDs at nearby center of the town and three FGDs at outskirts of the town were conducted to understand the location centric perspective of the respondents emanating from differential access to resources and benefits. The data gathered went through several phases of interpretative thematic analysis. Subsequently, three main themes were identified, “impact of urbanization,” “better life than before” and “cultural degradation”. The participants perceived that there has been a disruption in intergenerational relationship in contemporary times owing to shift from socio-cultural approach to economic approach to development. This study draws attention towards tribal elderly perspectives on intergenerational behaviors and relationships for researchers, academicians, practitioners and policy makers to design their interventions accordingly.

The chromatin remodeler Ino80 regulates yeast stress tolerance and cell metabolism through modulating nitrogen catabolite repression

Chromatin remodelers are important in maintaining the dynamic chromatin state in eukaryotic cells, which is essential for epigenetic regulation. Among the remodelers, the multi-subunits complex INO80 plays crucial roles in transcriptional regulation. However, current knowledge of chromatin regulation of the core subunit Ino80 on stress adaptation remains mysterious. Here we revealed that overexpressing the chromatin remodeler Ino80 elevated tolerance to multiple stresses in budding yeast Saccharomyces cerevisiae. Analyses of differential chromatin accessibility and global transcription levels revealed an enrichment of genes involved in NCR (nitrogen catabolite repression) under acetic acid stress. We demonstrated that Ino80 overexpression reduced the histone H3 occupancy in the promoter region of the glutamate dehydrogenase gene GDH2 and the allantoinase gene DAL1. Consistently, the decreased occupancy of nucleosome was revealed in the Ino80-inactivation mutant. Further analyses showed that Ino80 was recruited to the specific DNA locus in the promoter region of GDH2. Consistently, Ino80 overexpression facilitated the utilization of non-preferred nitrogen source to enhance ethanol yield under prolonged acetic acid stress. These results demonstrate that Ino80 plays a crucial role in coordinating carbon and nitrogen metabolism during stress adaptation.

Up-regulation of TNF-alpha/NFkB/SIRT1 axis drives aggressiveness and cancer stem cells accumulation in chemoresistant oral squamous cell carcinoma.

Tumor resistance remains an obstacle to successfully treating oral squamous cell carcinoma (OSCC). Cisplatin is widely used as a cytotoxic drug to treat solid tumors, including advanced OSCC, but with low efficacy due to chemoresistance. Therefore, identifying the pathways that contribute to chemoresistance may show new possibilities for improving the treatment. This work explored the role of the tumor necrosis factor-alpha (TNF-alpha)/NFkB signaling in driving the cisplatin resistance of OSCC and its potential as a pharmacological target to overcome chemoresistance. Differential accessibility analysis demonstrated the enrichment of opened chromatin regions in members of the TNF-alpha/NFkB signaling pathway, and RNA-Seq confirmed the upregulation of TNF-alpha/NFkB signaling in cisplatin-resistant cell lines. NFkB was accumulated in cisplatin-resistant cell lines and in cancer stem cells (CSC), and the administration of TNF-alpha increased the CSC, suggesting that TNF-alpha/NFkB signaling is involved in the accumulation of CSC. TNF-alpha stimulation also increased the histone deacetylases HDAC1 and SIRT1. Cisplatin-resistant cell lines were sensitive to the pharmacological inhibition of NFkB, and low doses of the NFkB inhibitors, CBL0137, and emetine, efficiently reduced the CSC and the levels of SIRT1, increasing histone acetylation. The NFkB inhibitors decreased stemness potential, clonogenicity, migration, and invasion of cisplatin-resistant cell lines. The administration of the emetine significantly reduced the tumor growth of cisplatin-resistant xenograft models, decreasing NFkB and SIRT1, increasing histone acetylation, and decreasing CSC. TNF-alpha/NFkB/SIRT1 signaling regulates the epigenetic machinery by modulating histone acetylation, CSC, and aggressiveness of cisplatin-resistant OSCC and the NFkB inhibition is a potential strategy to treat chemoresistant OSCC.

Analysis of Chromatin Accessibility and DNA Methylation to Reveal the Functions of Epigenetic Modifications in Cyprinus carpio Gonads.

Epigenetic modifications are critical in precisely regulating gene expression. The common carp (Cyprinus carpio) is an economically important fish species, and females exhibit faster growth rates than males. However, the studies related to epigenetic modifications in the common carp gonads are limited. In this study, we conducted the Assay for Transposase Accessible Chromatin sequencing (ATAC-seq) and Bisulfite sequencing (BS-seq) to explore the roles of epigenetic modifications in the common carp gonads. We identified 84,207 more accessible regions and 77,922 less accessible regions in ovaries compared to testes, and some sex-biased genes showed differential chromatin accessibility in their promoter regions, such as sox9a and zp3. Motif enrichment analysis showed that transcription factors (TFs) associated with embryonic development and cell proliferation were heavily enriched in ovaries, and the TFs Foxl2 and SF1 were only identified in ovaries. We also analyzed the possible regulations between chromatin accessibility and gene expression. By BS-seq, we identified 2087 promoter differentially methylated genes (promoter-DMGs) and 5264 gene body differentially methylated genes (genebody-DMGs) in CG contexts. These genebody-DMGs were significantly enriched in the Wnt signaling pathway, TGF-beta signaling pathway, and GnRH signaling pathway, indicating that methylation in gene body regions could play an essential role in sex maintenance, just like methylation in promoter regions. Combined with transcriptomes, we revealed that the expression of dmrtb1-like, spag6, and fels was negatively correlated with their methylation levels in promoter regions. Our study on the epigenetic modifications of gonads contributes to elucidating the molecular mechanism of sex differentiation and sex maintenance in the common carp.

LEVERAGING THE COMMUNITY AS PARTNERS TO ADVANCE CANCER RESEARCH IN SOCIALLY DIVERSE OLDER ADULT POPULATIONS

Abstract Older Black adults with cancer suffer a “double disadvantage” to their health due to the compounding effects of ageism and racism. This “double disadvantage” further fuels the disparities in cancer-related mortality observed for this population. For example, multiple myeloma (MM) is an incurable and debilitating blood cancer that predominantly affects older Black adults. Despite overall improvements in MM-related survival observed following the introduction of novel therapies, older Black persons with MM continue to die at twice the rate of their White counterparts. This survival gap is largely driven by differential healthcare access and disappears when older Black adults are given equal access to care. Using MM as a chronic disease model, we are partnering with a community advisory board to design and pilot test a community lay navigator program that seeks to address some of the upstream determinants of healthcare access that limit how older Black adults newly diagnosed with MM perceive the need for, seek, reach and engage with the healthcare system. Through our foundational qualitative work focused on older North Carolinians (patients and caregivers) affected by MM, we have identified the following multilevel (individual, interpersonal, and community level) intervention targets: trust, knowledge and health beliefs, availability and adequacy of social support, and patient empowerment. In addition, we are leveraging the resources of an established core (Rapid Case Ascertainment) housed within our Comprehensive Cancer Center and linked to the statewide N.C. Central Cancer Registry to facilitate early identification of eligible participants (within 4-8 weeks of diagnosis) and patient outreach.

DIFFERENCES IN MEDICARE RESOURCE USE BY ENGLISH PROFICIENCY

Abstract Medicare is complicated and coverage decisions can be complex. Accordingly, the Centers for Medicare & Medicaid Services (CMS) provides a hotline, handbook, and website to help Medicare beneficiaries understand their benefits and coverage options. In this study, we used 2016-2018 Medicare Current Beneficiary Survey data and linear probability models to assess whether the likelihood of CMS Medicare resource use differed between beneficiaries with English proficiency and those with limited English proficiency (LEP). Our primary outcome was an indicator of having used at least one CMS resource. We considered English proficiency in both speaking and reading. Limited English-speaking proficiency or, separately, limited English-reading proficiency signified that the beneficiary reported speaking or reading English “not well” or “not at all.” Among a nationally representative sample of noninstitutionalized Medicare beneficiaries, 5.7% had limited English-speaking proficiency, 8.7% had limited English-reading proficiency, and 67.0% had used a CMS resource. Adjusting for health and social factors, age, language spoken at home, county-level Medicare Advantage characteristics, and state and year fixed effects, beneficiaries with limited English-reading proficiency were 16.7 percentage points less likely to have used a CMS resource compared to beneficiaries who reported reading English “well” or “very well” (p <.001). Limited English-speaking proficiency was not associated with CMS resource use. These findings have implications for federal initiatives to improve language access in Medicare, particularly efforts to reduce literacy barriers. Differences in Medicare coverage choice and benefits utilization among beneficiaries with LEP may be partially explained by differential access to or engagement with written CMS Medicare information.

Racial and ethnic inequities in stillbirth in the US: Looking upstream to close the gap: Seminars in Perinatology

Though stillbirth rates in the United States improved over the previous decades, inequities in stillbirth by race and ethnicity have persisted nearly unchanged since data collection began. Black and Indigenous pregnant people face a two-fold greater risk of experiencing the devastating consequences of stillbirth compared to their White counterparts. Because race is a social rather than biological construct, inequities in stillbirth rates are a downstream consequence of structural, institutional, and interpersonal racism which shape a landscape of differential access to opportunities for health. These downstream consequences can include differences in the prevalence of chronic health conditions as well as structural differences in the quality of health care or healthy neighborhood conditions, each of which likely plays a role in racial and ethnic inequities in stillbirth. Research and intervention approaches that utilize an equity lens may identify ways to close gaps in stillbirth incidence or in responding to the health and socioemotional consequences of stillbirth. A community-engaged approach that incorporates experiential wisdom will be necessary to create a full picture of the causes and consequences of inequity in stillbirth outcomes. Investigators working in tandem with community partners, utilizing a combination of qualitative, quantitative, and implementation science approaches, may more fully elucidate the underpinnings of racial and ethnic inequities in stillbirth outcomes.