Background Postmastectomy breast reconstruction (BR) has been shown to provide long-term quality of life and psychosocial benefits. Despite the policies initiated to improve access to BR, its delivery continues to be inequitable, suggesting that barriers to access have not been fully identified and/or addressed. The purpose of this study was to assess the influence of geographic location, socioeconomic status, and race in access to immediate BR (IBR). Methods An institutional review board–approved observational study was conducted. All patients who underwent breast cancer surgery from 2014 to 2019 were queried from our institutional Breast Cancer Registry. A geographical analysis was conducted using demographic characteristics and patient’s ZIP codes. Euclidean distance from patient home ZIP code to UPMC Magee Women's Hospital was calculated, and χ2, Student t test, Mann-Whitney, and Kruskal-Wallis tests was used to evaluate differences between groups, as appropriate. Statistical significance was set at P < 0.05. Results Overall, 5835 patients underwent breast cancer surgery. A total of 56.7% underwent lumpectomy or segmental mastectomy, and 43.3% underwent modified, total, or radical mastectomy. From the latter group, 33.5% patients pursued BR at the time of mastectomy: 28.6% autologous, 48.1% implant-based, 19.4% a combination of autologous and implant-based, and 3.9% unspecified reconstruction. Rates of IBR varied among races: White or European (34.1%), Black or African American (27.7%), and other races (17.8%), P = 0.022. However, no difference was found between type of BR among races (P = 0.38). Moreover, patients who underwent IBR were significantly younger than those who did not pursue reconstruction (P < 0.0001). Patients who underwent reconstruction resided in ZIP codes that had approximately US $2000 more annual income, a higher percentage of White population (8% vs 11% non-White) and lower percentage of Black or African American population (1.8% vs 2.9%) than the patients who did not undergo reconstruction. Conclusions While the use of postmastectomy BR has been steadily rising in the United States, racial and socioeconomic status disparities persist. Further efforts are needed to reduce this gap and expand the benefits of IBR to the entire population without distinction.
Background Excessive alcohol consumption during pregnancy is associated with high risk of congenital heart defects, but it is unclear how alcohol specifically affects heart development during the acute aftermath of a maternal binge drinking episode. We hypothesize that administration of a single maternal binge dose of alcohol to pregnant mice at embryonic day 9.5 (E9.5) causes perturbations in the expression patterns of specific genes in the developing heart in the acute period (1–3 days) following the binge episode. To test this hypothesis and identify strong candidate ethanol‐sensitive target genes of interest, we adapted a mouse binge alcohol model that is associated with a high incidence of congenital heart defects as described below. Methods/Results Pregnant mice were administered a single dose of alcohol (2.5 g/kg in saline) or control (saline alone) via oral gavage. To evaluate the impact of maternal binge alcohol on cardiac gene expression profiles, we isolated embryonic hearts from both groups (n = 5/group) at 24, 48, and 72 h post‐gavage for transcriptomic analyses. RNA was extracted and evaluated using quantitative RNA‐sequencing (RNA‐Seq) methods. To identify a cohort of binge‐altered cardiac genes, we set the threshold for change at >2.0‐fold difference with adjusted p < 0.05 versus control. RNA‐Seq analysis of cardiac gene expression revealed that of the 17 genes that were altered within the first 48 h post‐binge, with the largest category consisting of transcription factors (Alx1, Alx4, HoxB7, HoxD8, and Runx2), followed by signaling molecules (Adamts18, Dkk2, Rtl1, and Wnt7a). Furthermore, multiple comparative and pathway analyses suggested that several of the candidate genes identified through differential RNA‐Seq analysis may interact through certain common pathways. To investigate this further, we performed gene‐specific qPCR analyses for three representative candidate targets: Runx2, Wnt7a, and Mlxipl. Notably, only Wnt7a showed significantly (p < 0.05) decreased expression in response to maternal binge alcohol in the qPCR assays. Conclusions These findings identify Wnt7a and a short list of potential other candidate genes and pathways for further study, which could provide mechanistic insights into how maternal binge alcohol consumption produces congenital cardiac malformations.
Students with intellectual disabilities (IDs) benefit most from an inclusive curriculum facilitating engagement with peers without IDs. While such curricula exist in primary and secondary education, inclusive postsecondary education (IPSE) is still new. Integrated IPSE allows students with and without IDs to take classes together, with further inclusion in residential life and extracurricular activities. In addition to fostering growth in students with IDs, this creates a diverse college experience for those without IDs, cultivating an informed and inclusive student body. Knights Exemplar (KE) is a student-led peer mentorship program supporting students with IDs enrolled in Inclusive Education Services (IES), an integrated IPSE program at the University of Central Florida (UCF). KE educates students to ensure peer mentors of the highest quality, serving as role models and bridging the gap between IES students and university resources. However, six months after KE was founded, UCF shut down due to safety concerns related to the COVID-19 pandemic. This sudden disruption to the organization’s functioning created an array of challenges that needed to be addressed in order to resume operation in a virtual capacity. In dealing with these struggles while prioritizing the social and emotional needs of the students in IES, we learned to adapt to new challenges and make the most of the circumstances of the COVID-19 pandemic. Ultimately, our experiences can serve as a lesson for other university-based IPSE programs seeking to provide more significant support to students with IDs in a virtual environment.
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