IMPORTANCE With transcranial Doppler (TCD) screening, we can identify children and adolescents with sickle cell anemia who are at the highest risk of stroke. An accurate claims-based method for identifying children and adolescents with sickle cell anemia was recently developed and validated that establishes the necessary groundwork to enable large population-based assessments of health services utilization among children and adolescents with sickle cell anemia using administrative claims data. OBJECTIVE To assess the feasibility of using administrative claims data to identify and describe the receipt of TCD screening among children and adolescents with sickle cell anemia and to characterize opportunities for intervention. DESIGN, SETTING, AND PARTICIPANTS Retrospective cross-sectional study using Medicaid claims data from 2005 to 2010. Medicaid claims data were obtained from the following states: Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Children and adolescents 2 to 16 years of age with sickle cell anemia were identified by the presence of 3 or more Medicaid claims with a diagnosis of sickle cell anemia within a calendar year (2005-2010). A total of 4775 children and adolescents contributed 10 787 person-years throughout the study period. Data were analyzed in 2015. A subset of children and adolescents enrolled for 2 or more consecutive years was identified to examine potential predictors of TCD screening, which included age, sex, previous receipt of TCD screening, state of residence, and health services utilization (well-child visits, outpatient visits, emergency department visits, and inpatient visits). MAIN OUTCOMES AND MEASURES Receipt of TCD screening was assessed by year and state. Using logistic regression with generalized estimating equations, we included associated predictors in a multivariable model to estimate odds of TCD screening. RESULTS For a total of 4775 children and adolescents 2 to 16 years of age, TCD screening rates increased over the 6-year study period from 22% to 44% (P < .001); rates varied substantially across states. A subset of 2388 children and adolescents with sickle cell anemia (50%) was enrolled for 2 or more consecutive years. Each year of increasing age was associated with 3% lower odds of TCD screening (odds ratio, 0.97 [95% CI, 0.95-0.98]; P = .002). Previous receipt of TCD screening (odds ratio, 2.44 [95% CI, 2.11-2.81]; P < .001) and well-child visits (odds ratio, 1.10 [95% CI, 1.03-1.18]; P = .007) were associated with higher odds of receiving a TCD screening. CONCLUSIONS AND RELEVANCE Despite national recommendations, TCD screening rates remain low. Successful strategies to improve TCD screening rates may capitalize on the numerous health care interactions among children and adolescents with sickle cell anemia.

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Despite national recommendations and proven lifesaving benefit, antibiotic prophylaxis rates are low among children with SCA. Numerous health care encounters may offer an opportunity for intervention; in addition, such interventions likely need to include social factors that may affect the ability for a child to receive and adhere to antibiotic prophylaxis.

We studied the linear and nonlinear temporal response properties of simple cells in cat visual cortex by presenting at single positions in the receptive field an optimally oriented bar stimulus whose luminance was modulated in a random, binary fashion. By crosscorrelating a cell's response with the input it was possible to obtain the zeroth-, first-, and second-order Wiener kernels at each RF location. Simple cells showed pronounced nonlinear temporal properties as revealed by the presence of prominent second-order kernels. A more conventional type of response histogram was also calculated by time-locking a histogram on the occurrence of the desired stimulus in the random sequence. A comparison of the time course of this time-locked response with that of the kernel prediction indicated that nonlinear temporal effects of order higher than two are unimportant. The temporal properties of simple cells were well represented by a cascade model composed of a linear filter followed by a static nonlinearity. These modelling results suggested that for simple cells, the nonlinearity occurs late and probably is a soft threshold associated with the spike generating mechanism of the cortical cell itself. This result is surprising in view of the known threshold nonlinearities in preceding lateral geniculate and retinal neurons. It suggests that geniculocortical connectivity cancels the earlier nonlinearities to create a highly linear representation inside cortical simple cells.

Highlights 60,000 asymptomatic individuals were assessed for SARS-CoV-2 antibody responses Increased Spike IgG correlates with antibody diversity and ACE2 binding inhibition COVID-19 patients had lower antibody responses compared with high asymptomatic responders Individuals can mount diverse immune responses to COVID-19 without symptoms