Who Pays First?: Medicaid Third-Party Liability in Florida and Virginia’s Birth-Related Neurological Injury Compensation Programs

In response to an impending obstetrician shortage and medical malpractice crisis, the states of Florida and Virginia adopted no-fault birth-related neurological injury compensation programs in the 1980s. Both of these programs provide lifetime coverage for eligible children with serious birth-related neurological injuries; however, both programs treated themselves as the payer of last resort and required families to submit claims to Medicaid first based on an inaccurate interpretation of Medicaid third party-liability (“TPL”) laws and the program-enabling statutes. Both programs’ policies treating themselves as the payer of last resort not only violated Federal and State Medicaid laws, they caused harm to the enrolled children and their families and resulted in False Claims Act lawsuits. This Article examines the Medicaid TPL policies in Florida and Virginia’s birth-related neurological injury compensation programs and a proposed program in Maryland as well as proposes recommendations for future statutory, administrative guidance, and policy changes to avoid Medicaid TPL issues in the future. It argues that clear and consistent legislation, policies, and administrative guidance are needed to address Medicaid TPL issues in existing programs and ensure similar issues do not recur in the future

The Romanian translation of the Francis Scale of Attitude Toward Christianity: internal consistency reliability, re-test reliability and construct validity among undergraduate students within a Greek Orthodox Culture

In order to contribute to a growing international research programme concerned with the correlates, antecedents and consequences of individual differences in attitude toward religion, the Francis Scale of Attitude toward Christianity was translated into Romanian and applied within a cultural context shaped by the Greek Orthodox tradition. Data provided by a sample of 158 students (mainly in their late teens and early twenties) supported the internal consistency reliability, re-test reliability and construct validity of this instrument and commended it for further use in studies conducted in Romania

Evaluation of patient perception towards dynamic health data sharing using blockchain based digital consent with the Dovetail digital consent application : a cross sectional exploratory study

Background New patient-centric integrated care models are enabled by the capability to exchange the patient’s data amongst stakeholders, who each specialise in different aspects of the patient’s care. This requires a robust, trusted and flexible mechanism for patients to offer consent to share their data. Furthermore, new IT technologies make it easier to give patients more control over their data, including the right to revoke consent. These characteristics challenge the traditional paper-based, single-organisation-led consent process. The Dovetail digital consent application uses a mobile application and blockchain based infrastructure to offer this capability, as part of a pilot allowing patients to have their data shared amongst digital tools, empowering patients to manage their condition within an integrated care setting. Objective To evaluate patient perceptions towards existing consent processes, and the Dovetail blockchain based digital consent application as a means to manage data sharing in the context of diabetes care. Method Patients with diabetes at a General Practitioner practice were recruited. Data were collected using focus groups and questionnaires. Thematic analysis of the focus group transcripts and descriptive statistics of the questionnaires was performed. Results There was a lack of understanding of existing consent processes in place, and many patients did not have any recollection of having previously given consent. The digital consent application received favourable feedback, with patients recognising the value of the capability offered by the application. Patients overwhelmingly favoured the digital consent application over existing practice. Conclusions Digital consent was received favourably, with patients recognising that it addresses the main limitations of the current process. Feedback on potential improvements was received. Future work includes confirmation of results in a broader demographic sample and across multiple conditions

Coaching Stressors in a Division II Historically Black University

Recently, studies have addressed the stressful nature of the coaching profession, identifying a multitude of stressors among coaches for Division I, national, and international programs (Durand-Bush, Collins, & McNeill, 2012; Frey, 2007; Levy, Nicholls, Marchant, & Polman, 2009; Olusoga, Butt, Hays, & Maynard, 2009). The purpose of this study was to further the research by studying coaches at a Historically Black College/University (HBCU) and Division II (DII) athletic program. Participants included seven head and five assistant coaches across seven sports. All coaches were interviewed, based on a preexisting interview guide (Olusoga et al., 2009). Data were content analyzed using previously agreed upon procedures and submitted in NVivo for further examination (Côté, Salmela, Baria, & Russell, 1993). Three higher order themes termed Interpersonal, Intrapersonal, and Contextual Stressors emerged and were composed of 16 lower order themes. The most commonly cited interpersonal stressors included athletes, expectations of others, and administration. Performance outcome and lack of control were the most common intrapersonal stressors. Finally, schedule, lack of resources, and job security were the most common contextual stressors. These findings emphasize the stressful nature of the job and the need to identify means for minimizing stressors to improve the athletic experience for all involved

Seabird ecology in high-energy environments: approaches to assessing impacts of marine renewables

It has been widely acknowledged that a global change in energy production, from fossil fuels to renewable sources, is required in order to reduce carbon dioxide outputs and help mitigate anthropogenic climate change. The UK is recognised as having one of the largest practical marine energy resources in Europe, including ‘wet renewables’ energy sources; tidal-stream and wave energy. Scotland, as well as having some of the best marine energy resources, also holds internationally important numbers of breeding seabirds. Both wave energy and tidal stream devices have the potential to place a new anthropogenic pressure on already declining seabird populations. Wet renewables are predicted to impact seabird populations through collision, disturbance, habitat loss and changes to food availability. However, few devices have been deployed to enable monitoring of impacts and there have been few studies of the ecological implications and magnitude of any impacts to these populations. The aim of this thesis is to address key knowledge gaps relating to our understanding of seabird ecology in high-energy marine environments, specifically exploring spatial, temporal and habitat drivers for their use of these areas. This is to help expand the scientific basis used to assess the impacts of marine renewable energy devices on marine birds. This thesis also aims to increase our understanding of bird survey requirements for wet renewable energy schemes to help develop methods for environmental impact assessment. Chapters 2, 3 and 4 demonstrate that marine birds show differing spatial and temporal patterns of abundance and behaviour within high-energy marine environments. By using shore-based vantage point methods in three high-energy areas in the Northern Isles, I explore some variations in vantage point methods. Chapter 5 provides the most extensive and up-to-date review of diving and foraging behaviour for UK marine bird species. I identify knowledge gaps including the species and parameters for which there are a paucity of studies. I demonstrate a more robust approach to data collection in these high-energy tidal stream, which can shed insight on how they are being used by marine birds, while the diving and foraging behaviour synthesis provided many of the values that are required to undertake underwater collision risk modeling. It is hoped that developers can adopt the approaches identified here, which will improve the accuracy of their assessments and improve monitoring of any potential impacts

MTN-001: Randomized Pharmacokinetic Cross-Over Study Comparing Tenofovir Vaginal Gel and Oral Tablets in Vaginal Tissue and Other Compartments

Background: Oral and vaginal preparations of tenofovir as pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection have demonstrated variable efficacy in men and women prompting assessment of variation in drug concentration as an explanation. Knowledge of tenofovir concentration and its active form, tenofovir diphosphate, at the putative vaginal and rectal site of action and its relationship to concentrations at multiple other anatomic locations may provide key information for both interpreting PrEP study outcomes and planning future PrEP drug development. Objective: MTN-001 was designed to directly compare oral to vaginal steady-state tenofovir pharmacokinetics in blood, vaginal tissue, and vaginal and rectal fluid in a paired cross-over design. Methods and Findings: We enrolled 144 HIV-uninfected women at 4 US and 3 African clinical research sites in an open label, 3-period crossover study of three different daily tenofovir regimens, each for 6 weeks (oral 300 mg tenofovir disoproxil fumarate, vaginal 1% tenofovir gel [40 mg], or both). Serum concentrations after vaginal dosing were 56-fold lower than after oral dosing (p<0.001). Vaginal tissue tenofovir diphosphate was quantifiable in ≥90% of women with vaginal dosing and only 19% of women with oral dosing. Vaginal tissue tenofovir diphosphate was ≥130-fold higher with vaginal compared to oral dosing (p<0.001). Rectal fluid tenofovir concentrations in vaginal dosing periods were higher than concentrations measured in the oral only dosing period (p<0.03). Conclusions: Compared to oral dosing, vaginal dosing achieved much lower serum concentrations and much higher vaginal tissue concentrations. Even allowing for 100-fold concentration differences due to poor adherence or less frequent prescribed dosing, vaginal dosing of tenofovir should provide higher active site concentrations and theoretically greater PrEP efficacy than oral dosing; randomized topical dosing PrEP trials to the contrary indicates that factors beyond tenofovir's antiviral effect substantially influence PrEP efficacy. Trial Registration: ClinicalTrials.gov NCT00592124

Capicua regulates neural stem cell proliferation and lineage specification through control of Ets factors

Capicua (Cic) is a transcriptional repressor mutated in the brain cancer oligodendroglioma. Despite its cancer link, little is known of Cic’s function in the brain. We show that nuclear Cic expression is strongest in astrocytes and neurons but weaker in stem cells and oligodendroglial lineage cells. Using a new conditional Cic knockout mouse, we demonstrate that forebrain-specific Cic deletion increases proliferation and self-renewal of neural stem cells. Furthermore, Cic loss biases neural stem cells toward glial lineage selection, expanding the pool of oligodendrocyte precursor cells (OPCs). These proliferation and lineage effects are dependent on de-repression of Ets transcription factors. In patient-derived oligodendroglioma cells, CIC re-expression or ETV5 blockade decreases lineage bias, proliferation, self-renewal, and tumorigenicity. Our results identify Cic as an important regulator of cell fate in neurodevelopment and oligodendroglioma, and suggest that its loss contributes to oligodendroglioma by promoting proliferation and an OPC-like identity via Ets overactivity

Ancestral exposure to stress epigenetically programs preterm birth risk and adverse maternal and newborn outcomes

Sherpa Romeo green journal: open accessAbstract Background: Chronic stress is considered to be one of many causes of human preterm birth (PTB), but no direct evidence has yet been provided. Here we show in rats that stress across generations has downstream effects on endocrine, metabolic and behavioural manifestations of PTB possibly via microRNA (miRNA) regulation. Methods: Pregnant dams of the parental generation were exposed to stress from gestational days 12 to 18. Their pregnant daughters (F1) and grand-daughters (F2) either were stressed or remained as non-stressed controls. Gestational length, maternal gestational weight gain, blood glucose and plasma corticosterone levels, litter size and offspring weight gain from postnatal days 1 to 30 were recorded in each generation, including F3. Maternal behaviours were analysed for the first hour after completed parturition, and offspring sensorimotor development was recorded on postnatal day (P) 7. F0 through F2 maternal brain frontal cortex, uterus and placenta miRNA and gene expression patterns were used to identify stress-induced epigenetic regulatory pathways of maternal behaviour and pregnancy maintenance. Results: Progressively up to the F2 generation, stress gradually reduced gestational length, maternal weight gain and behavioural activity, and increased blood glucose levels. Reduced offspring growth and delayed behavioural development in the stress cohort was recognizable as early as P7, with the greatest effect in the F3 offspring of transgenerationally stressed mothers. Furthermore, stress altered miRNA expression patterns in the brain and uterus of F2 mothers, including the miR-200 family, which regulates pathways related to brain plasticity and parturition, respectively. Main miR-200 family target genes in the uterus, Stat5b, Zeb1 and Zeb2, were downregulated by multigenerational stress in the F1 generation. Zeb2 was also reduced in the stressed F2 generation, suggesting a causal mechanism for disturbed pregnancy maintenance. Additionally, stress increased placental miR-181a, a marker of human PTB. Conclusions: The findings indicate that a family history of stress may program central and peripheral pathways regulating gestational length and maternal and newborn health outcomes in the maternal lineage. This new paradigm may model the origin of many human PTB causes.Ye

Phase II study of induction chemotherapy with TPF followed by radioimmunotherapy with Cetuximab and intensity-modulated radiotherapy (IMRT) in combination with a carbon ion boost for locally advanced tumours of the oro-, hypopharynx and larynx - TPF-C-HIT

<p>Abstract</p> <p>Background</p> <p>Long-term locoregional control in locally advanced squamous cell carcinoma of the head and neck (SCCHN) remains challenging. While recent years have seen various approaches to improve outcome by intensification of treatment schedules through introduction of novel induction and combination chemotherapy regimen and altered fractionation regimen, patient tolerance to higher treatment intensities is limited by accompanying side-effects. Combined radioimmunotherapy with cetuximab as well as modern radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) and carbon ion therapy (C12) are able to limit toxicity while maintaining treatment effects. In order to achieve maximum efficacy with yet acceptable toxicity, this sequential phase II trial combines induction chemotherapy with docetaxel, cisplatin, and 5-FU (TPF) followed by radioimmunotherapy with cetuximab as IMRT plus carbon ion boost. We expect this approach to result in increased cure rates with yet manageable accompanying toxicity.</p> <p>Methods/design</p> <p>The TPF-C-HIT trial is a prospective, mono-centric, open-label, non-randomized phase II trial evaluating efficacy and toxicity of the combined treatment with IMRT/carbon ion boost and weekly cetuximab in 50 patients with histologically proven locally advanced SCCHN following TPF induction chemotherapy. Patients receive 24 GyE carbon ions (8 fractions) and 50 Gy IMRT (2.0 Gy/fraction) in combination with weekly cetuximab throughout radiotherapy. Primary endpoint is locoregional control at 12 months, secondary endpoints are disease-free survival, progression-free survival, overall survival, acute and late radiation effects as well as any adverse events of the treatment as well as quality of life (QoL) analyses.</p> <p>Discussion</p> <p>The primary objective of TPF-C-HIT is to evaluate efficacy and toxicity of cetuximab in combination with combined IMRT/carbon ion therapy following TPF induction in locally advanced SCCHN.</p> <p>Trial Registration</p> <p>Clinical Trial Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01245985">NCT01245985</a> (clinicaltrials.gov)</p> <p>EudraCT number: 2009 - 016489- 10</p

Integrating plant physiology into simulation of fire behavior and effects

Wildfires are a global crisis, but current fire models fail to capture vegetation response to changing climate. With drought and elevated temperature increasing the importance of vegetation dynamics to fire behavior, and the advent of next generation models capable of capturing increasingly complex physical processes, we provide a renewed focus on representation of woody vegetation in fire models. Currently, the most advanced representations of fire behavior and biophysical fire effects are found in distinct classes of fine-scale models and do not capture variation in live fuel (i.e. living plant) properties. We demonstrate that plant water and carbon dynamics, which influence combustion and heat transfer into the plant and often dictate plant survival, provide the mechanistic linkage between fire behavior and effects. Our conceptual framework linking remotely sensed estimates of plant water and carbon to fine-scale models of fire behavior and effects could be a critical first step toward improving the fidelity of the coarse scale models that are now relied upon for global fire forecasting. This process-based approach will be essential to capturing the influence of physiological responses to drought and warming on live fuel conditions, strengthening the science needed to guide fire managers in an uncertain future