Geographical Location Research Articles

Non-Hodgkin lymphoma mortality disparities across different sexes, races, and geographic locations.

Non-Hodgkin lymphoma (NHL) is one of the most common hematological cancers in the United States. The mortality rate of NHL in the United States is the sixth highest among all cancers. Our cross-sectional study aims to examine the trends and disparity in NHL mortality. We analyzed death certificate data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) United States to determine the NHL mortality trends among the U.S. population aged ≥15 years. NHL (ICD-10 C82-85) was listed as the underlying cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and joinpoint trend analysis were performed to determine the average annual percent change (AAPC) in AAMR trends. From 1999 to 2020, NHL accounted for 457,143 deaths in the United States, of which 54% are men and 46% are women. The NHL AAMR decreased significantly from 10.59 to 6.21 per 100,000 individuals with an AAPC of -2.55. Men had a higher AAMR than women (10.10 vs 6.29 per 100,000 individuals). Whites recorded the highest AAMR (8.43 per 100,000 individuals), followed by Hispanics (6.32 per 100,000 individuals), Blacks (5.71 per 100,000 individuals), American Indians (5.31 per 100,000 individuals), and Asians (5.10 per 100,000 individuals). Those who lived in the Midwest and the rural areas had the highest AAMR at 8.60 and 8.35 per 100,000 individuals respectively. Despite the declining NHL mortality rate, this study calls for targeted intervention to improve outcomes for susceptible individuals affected by NHL.

Urban green total factor energy efficiency and its decomposition under a multidimensional heterogeneity framework: a case study of the Yellow River Basin, China.

Assessing and monitoring the green total factor energy efficiency (GTFEE) of cities while considering technology heterogeneity is crucial for the development of energy-conservation and emission-reduction policies. Considering that the heterogeneity of production technologies encompasses several dimensions, this paper proposes a 3E3S (Economy-Environment-Energy-Society-Science-Space) heterogeneity framework and integrates it with the improved meta-frontier global SBM-undesirable to analyze GTFEE and its decomposition. Empirical analysis of cities in the Yellow River Basin of China (YRBC) highlights the following: (1) The 3E3S heterogeneity framework facilitates the classification of all cities into three distinct groups, a finding that contrasts significantly with previous outcomes documented in the literature that relied solely on criteria such as geographic location. (2) The three groups identified under the meta-frontier exhibit substantial energy-saving potentials of 24.49%, 35.17%, and 52.46%, respectively. Additionally, there are spatiotemporal variations in GTFEE, with cities located in the central part of YRBC, particularly those in Shanxi province, demonstrating poor GTFEE performance. (3) The decomposition analysis of GTFEE indicates that technological progress plays a pivotal role in enhancing GTFEE on the whole, albeit with varying approaches for improving GTFEE depending on individual cities.

Comparing the Efficacy of Robotic Versus Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.

Laparoscopic sleeve gastrectomy (LSG) has emerged as the predominant metabolic bariatric surgery. With a growing number of studies evaluating the feasibility of robotic sleeve gastrectomy (RSG), it becomes imperative to ascertain whether the outcomes of both techniques are comparable. This study endeavors to synthesize existing evidence and juxtapose the surgical outcomes of LSG and RSG. We collected articles comparing LSG and RSG published between 2011 and 2024. The compiled data included author names, study duration, sample size, average age, gender distribution, geographical location, preoperative body mass index (BMI), bougie diameter, duration of hospitalization, surgical duration, readmission rates, conversion rates, costs, postoperative percentage of excess weight loss (%EWL), postoperative BMI, mortality rates, and complications. We incorporated 21 articles. Both the RSG and LSG cohorts exhibited comparable rates of readmission, conversion, mortality, and incidence of complications (p > 0.05). Moreover, the efficacy of weight loss was similar between RSG and LSG. Nonetheless, RSG was linked to longer operative duration (WMD, -27.50 minutes; 95% confidence interval [CI], -28.82 to -26.18; p < 0.0001), prolonged hospitalization (WMD, -0.15 days; 95% CI, -0.25 to -0.04; p = 0.006), and elevated expenses (WMD, -5830.9 dollars; 95% CI, -8075.98 to -3585.81; p < 0.0001). While both RSG and LSG demonstrated positive postoperative clinical outcomes, RSG patients experienced extended hospital stays, longer operative times, and increased hospitalization costs compared to LSG patients. Using the robotic platform for sleeve gastrectomy (SG) in patients with obesity did not appear to offer any clear benefits.

The Association between Social Support and Pre-Exposure Prophylaxis use among Sexual Minority Men in the United States: A Scoping Literature Review.

Sexual minority men (SMM) are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is an effective way of reducing HIV incidence, PrEP use has remained relatively low. Social support may be one effective factor in increasing PrEP use among SMM, but the association between social support and PrEP use/adherence is not well understood. The objective of this paper was to summarize the current literature on the association of social support and PrEP use among SMM in the United States. A systematic search was conducted using six different databases MEDLINE / PubMed, PsycINFO, Cochrane CENTRAL, Google Scholar, Embase, and Web of Science using terms established from keywords and medical subject headings (MeSH) terms before being adapted to each database. Data were extracted for key study factors (e.g., study population, geographic location, study design) and main findings. This search produced eleven articles: ten manuscripts and one conference abstract. Of these, two were randomized control trials, two were interventions, three were qualitative, and four were cross-sectional. The studies were widespread across the country, but most were in major metropolitan areas. From the articles included in this review, findings were inconsistent in the association between social support; some studies showed null findings, others that only certain sources of social support were significant, and others that there was a significant association between social support and PrEP use. This review highlights the complexity of the relationship between social support and PrEP use among SMM, indicating the need for further research to identify specific types and sources of support that effectively enhance PrEP uptake and adherence. Targeted interventions based on these insights could significantly reduce HIV incidence in the population.

NIH funding and journal selection: trends in dermatology publication models across tiers from 2021 to 2023.

This study examines the influence of National Institutes of Health (NIH) funding on the publication choices of dermatologists, particularly in terms of journal tiers and pay-to-publish (P2P) versus free-to-publish (F2P) models. Utilizing k-means clustering for journal ranking based on SCImago Journal Rank, h-index, and Impact Factor, journals were categorized into three tiers and 54,530 dermatology publications from 2021 to 2023 were analyzed. Authors were classified as Top NIH Funded or Non-Top NIH Funded according to Blue Ridge Institute for Medical Research rankings. The study finds significant differences in publication patterns, with Top NIH Funded researchers in Tier I journals demonstrating a balanced use of P2P and F2P models, while they preferred F2P models in Tier II and III journals. Non-Top NIH Funded authors, however, opted for P2P models more frequently across all tiers. These data suggest NIH funding allows researchers greater flexibility to publish in higher-tier journals despite publication fees, while prioritizing F2P models in lower-tier journals. Such a pattern indicates that funding status plays a critical role in strategic publication decisions, potentially impacting research visibility and subsequent funding. The study's dermatology focus limits broader applicability, warranting further research to explore additional factors like geographic location, author gender, and research design.

Practice Trends and Geographic Locations of Newly Graduated Micrographic Surgery and Dermatologic Oncology Fellows.

Practice Trends and Geographic Locations of Newly Graduated Micrographic Surgery and Dermatologic Oncology Fellows.

A spatial approach to uncovering the socio-environmental injustice of noise pollution

ABSTRACT There is growing evidence of socio-environmental injustice related to road noise pollution among marginalised populations. Patterns of inequality are not constant across space, and understanding the local and regional scales of environmental injustice is critical for appropriate policy and public health interventions. This study used road noise exposure data from the 2018 National Transportation Noise Map, socio-demographic variables from the U.S. Census Bureau, and advanced spatial modeling to examine the socio-environmental injustice of road noise pollution in Texas census tracts (N = 5265). Local spatial regressions predicted higher coefficients of noise pollution in census tracts with higher minority populations, higher poverty, and higher social deprivation. Strong associations were specifically identified in the rural southern and eastern border areas of Texas. Findings from this study may guide policymakers and public health agencies in identifying geographic locations where interventions can be pinpointed to target socio-spatial noise pollution disparities in Texas.

An overview of down syndrome

The most prevalent chromosomal disorder linked to intellectual disability is down syndrome, often known as Down's syndrome (DS), which is marked by a number of distinct clinical symptoms. About 1 in 800 newborns globally experience it. Approximately 500 live births are caused by DS each year in the US, while over 200,000 people are affected by the disorder. The first account of the syndrome dates back to 1866 and is credited to the English physician John Langdon Down of Cornwall. When the chromosomal cause of the disorder was identified more than 90 years later, it was termed Down syndrome. Although there is still inequality in access to health care and other supportive services, the potential for the development and socialization of people with Down syndrome has been more widely recognized, and early support for impacted children and their families is extensively adopted. Patients vary greatly in their phenotypic characteristics; intellectual disability is typically moderate but can be mild to severe, and social function is frequently good in comparison to cognitive impairment. Geographical location and ethnic origin also have an impact on the incidence and presentation of DS.

The Optimal Selection of Renewable Energy Systems Based on MILP for Two Zones in Mexico

This paper presents a series of enhancements to a previously proposed mixed-integer linear programming (MILP) model for investment decisions and operational planning in distributed generation (DG) systems. The main contribution of this study consists of integrating a wind generation system and multiple loads at different buses in a network. The model considers dynamic weather data, energy prices, costs related to photovoltaic and wind systems, storage systems, operational and maintenance costs, and other pertinent factors, such as efficiencies, geographical locations, resource availability, and different load profiles. The simulation results obtained through implementation in Julia’s programming language illustrate that the MILP formulation maximizes the net present value, and four configurations for hybrid power generation systems in Mexico are analyzed. The objective is to enable profitability assessment for investments in large-capacity DG systems in two strategic zones of Mexico. The results show that the configurations in the NE zone, especially in Tamaulipas, are the most cost-effective. Case 1 stands out for its highest net present value and shortest payback time, while Case 2 offers the highest energy savings. In addition, Cases 3 and 4, which incorporate storage systems, exhibit the longest payback periods and the lowest savings, indicating less favorable economic performance compared with Cases 1 and 2. Moreover, the sales of two case studies, one without a storage system and the other with a storage system, are shown. The model also incorporates instruments for buying or selling energy in the wholesale electricity market, including variables that depict the injected energy into the electrical grid. This comprehensive approach provides a detailed overview of optimal energy management.

Social Determinants of Health and Patient-Reported Difficult Discontinuation of Long-Acting Reversible Contraception.

Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person's reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one's entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.

Examining school crisis plan components using the comprehensive crisis plan checklist—Second edition

AbstractCreating a plan for crisis prevention, intervention, and postvention procedures allows schools to prepare for the traumatic consequences when a crisis inevitably occurs. The comprehensive crisis plan checklist—second edition (CCPC‐2; McCleary &amp; Aspiranti, 2020) is a 102‐item tool created for evaluating individual school and district crisis plans. The current study examined existing crisis plans from school districts across the United States to determine the amount and type of CCPC‐2 items that are present within school crisis plans. The number of CCPC‐2 items represented on the 73 plans evaluated ranged from 0 to 67 with a mean of 22.29 items. The average number of plans that included a single item on the CCPC‐2 was 16. There were no significant differences in the number of CCPC‐2 items represented across different geographic locations, urbanicity (urban, suburban, rural), or district/school‐level plan type. Discussion focuses on how crisis teams within the schools can use the CCPC‐2 when creating, reviewing, or revising their district‐ or school‐level crisis plan.

Monitoring the effects of climate change and topography on vegetation health in Tharparkar, Pakistan

ABSTRACT Pakistan's geographic position and socioeconomic profile make it one of the nations that are particularly susceptible to the negative effects of climate change. The Tharparkar district in Pakistan is of particular importance in this regard as it is an arid region with serious environmental issues like drought, desertification, and soil degradation. Therefore, the purpose of this study is to examine how topographic and climatic factors affect vegetation indicators in the Tharparkar. The study utilizes spatiotemporal data spanning over 20 years (2001–2020) collected from the satellites MOD11A2 and MOD13A3. The collected data are processed using a range of tools in ArcGIS 10.4.1, and the impact of topographic and climatic conditions is analyzed based on different vegetation indices, including EVI, NDVI, STVI, OSAVI, and SAVI. The findings reveal that temperature and precipitation, both of which are controlled by topographic features, such as elevation and slope, are the key elements affecting vegetation in Tharparkar. At high elevations, rainfall (&amp;gt;440 mm) and LST (&amp;gt;39 °C) are also high and where the slope is low the density of vegetation indices is high.

Bayesian phylogenetic analysis of pitch-accent systems based on accentual class merger: a new method applied to Japanese dialects

Abstract Unlike studies of the evolutionary relationship between languages, the dialect-level variation within a language has seldom been studied within the framework of a phylogenetic tree, because frequent lexical borrowing muddles the evidence of shared ancestry. The phonological history of Japanese is an exceptional case study where the phenomenon called accentual class merger enables the phylogenetic analysis of dialectal pitch-accent systems in a way that is not subject to borrowing. However, previous studies have lacked statistical analysis and failed to evaluate the relative credence of alternative hypotheses. Here we developed a novel substitution model that describes the mutation of pitch-accent systems driven by accentual class merger and integrated the model into the framework of Bayesian phylogenetic inference with geographical diffusion. Applying the method to data on the pitch-accent variation in modern Japanese dialects and historical documents collected from literature, we reconstructed the evolutionary history and spatial diffusion of pitch-accent systems. Our result supports the monophyly of each of three groups of pitch-accent systems in conventional categorization, namely Tokyo type, Keihan type, and N-kei (N-pattern) type of Kyushu, whereas the monophyly of the Tokyo type has been highly controversial in previous studies. The divergence time of the mainland pitch-accent systems was estimated to be from mid-Kofun to early Heian period. Also, it is suggested that the modern Kyoto dialect did not inherit its accent patterns from Bumoki but from an unrecorded lineage which survived from the Muromachi period. Analyses on geographical diffusion suggest that the most recent common ancestor (MRCA) of all the taxa and that of Keihan type were located in or around the Kinki region, whereas the MRCA of N-kei type was located in northern to central Kyushu. The geographical location of the MRCA of Tokyo type remains unclear, but the Kinki and Kanto regions are the most plausible candidates.

Neotropical non‐primate canopy mammals: historical trends, omissions, and geographic gaps in the knowledge

ABSTRACT Canopy mammals constitute a diverse and widely distributed group. However, these species have not been widely studied, and there are currently many gaps in our knowledge of their ecology, behaviour, distribution, and conservation status. We identified crucial trends and omissions in terms of research effort on research themes, taxonomic groups, countries, and protected areas (PAs) and geographic information biases. A systematic review was conducted by consulting two electronic databases (Web of Science and Scopus), including research conducted within neotropical countries (from central Mexico to northern Argentina) until the end of the first half of 2021. All the references obtained were reviewed and categorised, and the geographical location of each study was extracted to evaluate geographical gaps. We found that two orders (Carnivora and Didelphimorphia) and three families (Didelphidae, Felidae, and Cricetidae) were the most studied taxa, and were featured in more than 50% of cases. Brazil had the highest number of studies. Topics concerning diseases (19% of cases), distribution (14%), and ecology (14%) were the most frequently addressed; only 4.6% of the studies focused on anthropogenic disturbances, and less than 30% of the studies were conducted within PAs. We found that one of the largest and most important geographical biases in knowledge was in the northern Amazon region, where the number of studies was low or null. This study lays the groundwork for future research on these understudied mammals, to develop better research that can allow us to design more appropriate conservation strategies.

Spatial Distribution Characteristics and Driving Factors of Little Giant Enterprises in China’s Megacity Clusters Based on Random Forest and MGWR

As a representative of potential “hidden champions”, a concept originating in Germany, specialized and innovative Little Giant Enterprises (LGEs) have become exemplary models for small and medium-sized enterprises (SMEs) in China. These enterprises are regarded as crucial support for realizing the strategy of building a strong manufacturing country and addressing the weaknesses in key industrial areas. This paper begins by examining urban agglomerations, which serve as the main spatial carriers for industrial restructuring and high-quality development in manufacturing. Based on data from LGEs in the Yangtze River Delta (YRD) and Pearl River Delta (PRD) urban agglomerations from 2019 to 2023, the study employs the Random Forest (RF) and Multi-scale Geographically Weighted Regression (MGWR) methods to conduct a comparative analysis of their spatial patterns and influencing factors. The results are as follows: (1) LGEs exhibit spatial clustering in both the YRD and PRD regions. Enterprises in the YRD form a “one-axis-three-core” pattern within a distance of 65 km, while enterprises in the PRD present a “single-axis” pattern within a distance of 30 km, with overall high clustering intensity. (2) The YRD is dominated by traditional manufacturing and supplemented by high-tech services. In contrast, the PRD has a balanced development of high-tech manufacturing and services. Enterprises in different industries are generally characterized by a “multi-point clustering” characteristic, of which the YRD displays a multi-patch distribution and the PRD a point–pole distribution. (3) Factors such as industrial structure, industrial platforms, and logistics levels significantly affect enterprise clustering and exhibit scale effects differences between the two urban clusters. Factors such as industrial platforms, logistics levels, and dependence on foreign trade show positive impacts, while government fiscal expenditure shows a negative impact. Natural geographical location factors exhibit opposite effects in the two regions but are not the primary determinants of enterprise distribution. Each region should leverage its own strengths, improve urban coordination and communication mechanisms within the urban cluster, strengthen the coordination and linkage of the manufacturing industry chain upstream and downstream, and promote high-tech industries, thereby enhancing economic resilience and regional competitiveness.

Empowering Youths for Social Changes: Educational Initiatives in Gandaki Rural Municipality, Ward No. 6

The study aims to discern the role of education on youth empowerment to promote health and sanitation, gender equality and awareness to address social issues for social changes in Gandaki Rural Municipality ward number 6. The survey study identified various challenges related to education for youth empowerment. The descriptive research design was used. The focused group discussions using semi-structured questionnaires were administered to the seven youths of Chepang/Praja community aged 15-19 years old residing in the ward number 6. The sample was selected using purposive sampling technique. The education the youth of Chepang/Praja community empowered through education demonstrated the ability to promotes health and sanitation, gender equality and create awareness to address social issues within their society. Major challenges identified includes reluctance to change by the senior citizens, lack of priority to the training that didn't provide allowances, the voices of youth are unheard, remote geographical location, lack the access to transportation, lacks appropriate resources and migration. The study suggested that the education brings positive social changes through empowering the youth in the promotion of health and sanitation, gender equality and creation of awareness to address the social changes.

Local factors or altitudinal gradient: which one is effective on diatom communities and ecological status in the 23 lentic systems of the Sakarya Basin (Türkiye)?

In the 23 lentic systems of the Sakarya Basin, littoral diatoms and environmental variables were assessed with the samples collected in the spring, summer, and fall of 2018 to determine the effect of altitude or local factors on diatom assemblages. A total of 210 diatom taxa in 63 genera were identified during the studied period. Both the distribution of indicator species and the species composition were affected by pH, electrical conductivity, alkalinity, total organic carbon, total nitrogen, and total phosphorus. Especially low alkalinity was found to be effective in the distribution of high-altitude optima species. Close geographical location was also important in shaping species composition. Although the species richness and diversity of lentic systems on > 1600m a.s.l. were higher than those in lower altitudes, pH and total phosphorus were the determinant factors. On the other hand, altitude indirectly affected all these factors by causing habitat diversity. The Leclercq and Maquet Diatomic Index showed a higher correlation with total nitrogen, total organic carbon, and total phosphorus. This index was more effective in determining the ecological status of 23 lentic systems. Altitude has also an indirect effect on the ecological status of these systems by restricting anthropogenic pressure such as total phosphorus.

Trends in traffic accident mortality and social inequalities in Ecuador from 2011 to 2022

BackgroundTraffic accidents (TA) remain a significant global public health concern, impacting low—and middle-income countries. This study aimed to describe the trend in TA mortality and inequalities in Ecuador for 2011–2022, distributed by year, gender, age group, geographical location, type of accident, and social inequalities.MethodsAn ecological study was conducted using INEC national-level data on TA fatalities in Ecuador. Mortality rates were calculated per 100,000 population and analyzed by year, gender, age group, geographic region, and accident type. Annual percentage variation (APV) was determined using linear regression models. Inequality analyses examined associations between TA mortality and socioeconomic factors like per capita income and literacy rates. Complex measures such as the Slope Inequality Index (SII) were calculated to assess the magnitude of inequalities.ResultsThere were 38,355 TA fatalities in Ecuador from 2011 to 2022, with an overall mortality rate of 19.4 per 100,000 inhabitants. The rate showed a non-significant decreasing trend (APV − 0.4%, p = 0.280). Males had significantly higher mortality rates than females (31.99 vs. 7.19 per 100,000), with the gender gap widening over time (APV 0.85%, p = 0.003). The Amazon region had the highest rate (24.4 per 100,000), followed by the Coast (20.4 per 100,000). Adults aged ≥ 60 years had the highest mortality (31.0 per 100,000), followed by those aged 25–40 years (28.6 per 100,000). The ≥ 60 age group showed the most significant rate decrease over time (APV − 2.25%, p < 0.001). Pedestrians were the most affected group after excluding unspecified accidents, with a notable decreasing trend (APV − 5.68%, p < 0.001). Motorcyclist fatalities showed an increasing trend, ranking third in TA-related deaths. Lower literacy rates and per capita income were associated with higher TA mortality risks. Inequality in TA mortality between provinces with the highest and lowest per capita income increased by 247.7% from 2011 to 2019, as measured by the SII.ConclusionWhile overall TA mortality slightly decreased in Ecuador, significant disparities persist across demographic groups and geographic regions. Older adults, males, pedestrians, and economically disadvantaged populations face disproportionately higher risks. The increasing trend in motorcycle-related fatalities and widening socioeconomic inequalities are particularly concerning.

Genotype-Specific Activation of Autophagy during Heat Wave in Wheat

Recycling of unnecessary or dysfunctional cellular structures through autophagy plays a critical role in cellular homeostasis and environmental resilience. Therefore, the autophagy trait may have been unintentionally selected in wheat breeding programs for higher yields in arid climates. This hypothesis was tested by measuring the response of three common autophagy markers, ATG7, ATG8, and NBR1, to a heat wave under reduced soil moisture content in 16 genetically diverse spring wheat landraces originating from different geographical locations. We observed in the greenhouse trials that ATG8 and NBR1 exhibited genotype-specific responses to a 1 h, 40 °C heat wave, while ATG7 did not show a consistent response. Three genotypes from Uruguay, Mozambique, and Afghanistan showed a pattern consistent with higher autophagic activity: decreased or stable abundance of both ATG8 and NBR1 proteins, coupled with increased transcription of ATG8 and NBR1. In contrast, three genotypes from Pakistan, Ethiopia, and Egypt exhibited elevated ATG8 protein levels alongside reduced or unaltered ATG8 transcript levels, indicating a potential suppression or no change in autophagic activity. Principal component analysis demonstrated a correlation between lower abundance of ATG8 and NBR1 proteins and higher yield in the field trials. We found that (i) the combination of heat and drought activated autophagy only in several genotypes, suggesting that despite being a resilience mechanism, autophagy is a heat-sensitive process; (ii) higher autophagic activity correlates positively with greater yield; (iii) the lack of autophagic activity in some high-yielding genotypes suggests contribution of alternative stress-resilient mechanisms; and (iv) enhanced autophagic activity in response to heat and drought was independently selected by wheat breeding programs in different geographic locations.

DISPARITIES IN ACCESS TO REPRODUCTIVE GENETIC SERVICES ASSOCIATED WITH GEOGRAPHIC LOCATION OF RESIDENCE AND MATERNAL ETHNICITY

To describe the association between geographic location of residence and use of aneuploidy screening or prenatal genetic counseling, and how it is modified by maternal race and ethnicity. Retrospective cohort of individuals at a tertiary-care center between 2017-19. County of residence was classified as rural or metropolitan based on US Office of Management and Budget 2019 definitions. Maternal race and ethnicity were self-identified. Our composite outcome was defined as use of aneuploidy screening or genetic counseling visit. The composite outcome was compared by geographic location and ethnicity. Logistic regression was used to model the relationship between geographic location and the composite outcome. 8774 pregnancies were included. 4770 (54%) had genetic screening and 3,781 (43%) had at least one genetic-counseling (GC) visit. Rural patients were significantly less likely to have the composite outcome compared to metropolitan peers (37.1% vs. 47.2%, p<0.001). In addition, we identified differences in the composite outcome between White rural patients and LatinX rural patients (37.7% vs. 35.6%, p<0.001), and between Asian rural patients and LatinX and Black rural patients (41.0% vs. 35.6%, p<0.001; 41.0% vs. 36.8%, p<0.001). Logistic regression demonstrated rural patients were significantly less likely to have the composite outcome compared to metropolitan peers, after adjusting for LatinX ethnicity and gestational age at first prenatal visit (OR 0.72, [0.55, 0.95], p=0.002. Rural, minority patients were significantly less likely to receive reproductive genetic services compared to metropolitan peers extending our knowledge of disparities in maternity care.