Long-Term Care Policy after Covid-19 — Solving the Nursing Home Crisis

Nursing homes have been caught in the crosshairs of the coronavirus pandemic. As of early May 2020, Covid-19 had claimed the lives of more than 28,000 nursing home residents and staff in the United States. But U.S. nursing homes were unstable even before Covid-19 hit. The tragedy unfolding in nursing homes is the result of decades of neglect of long-term care policy.Beyond the pandemic, we will have to transform the way we pay for and provide long-term care. First, Medicaid programs need to invest considerably more in care in all settings, including home-based settings as Medicaid shifts a larger share of care into them. Second, because caregiving at home is not feasible for many care recipients and families, we also need safe, affordable residential options. Better residential options can help ensure that the tragedy currently unfolding in nursing homes never happens again. Finally, we believe that the United States needs to reconsider our piecemeal approach to paying for long-term care. Existing programs, such as Medicare and Medicaid, would have to fundamentally change the way they pay for long-term care to meet the needs of our aging population. We can look to other countries for more coherent financing systems.More funding alone is not the answer. Nor is more regulation a sufficient response. Rather, we need a combination of funding, regulation, and a new strategy that fully supports a range of institutional and noninstitutional care

Policy Options for Financing Long-Term Care in the U.S.

Unlike many other developed nations, the U.S. has no system that protects its residents against the high costs of long-term care, which many people will need as they age. Medicaid coverage kicks in only after families have exhausted their resources. Until then, families bear the financial and caregiving burden of LTC themselves. In the absence of a national system, several states have considered or passed programs that offer some support for LTC. Many peer nations have more comprehensive systems to spread the risk for LTC costs across their population, through social insurance or other mechanisms. This Issue Brief reviews international models of financing LTC, as well as recent state efforts, to help U.S. policymakers design a program that can meet the LTC challenges of an aging population

The lymphoproliferative defect in CTLA-4-deficient mice is ameliorated by an inhibitory NK cell receptor

T-cell responses are regulated by activating and inhibiting signals. CD28 and its homologue, cytotoxic T-lymphocyte antigen 4 (CTLA-4), are the primary regulatory molecules that enhance or inhibit T-cell activation, respectively. Recently it has been shown that inhibitory natural killer (NK) cell receptors (NKRs) are expressed on subsets of T cells. It has been proposed that these receptors may also play an important role in regulating T-cell responses. However, the extent to which the NKRs modulate peripheral T-cell homeostasis and activation in vivo remains unclear. In this report we show that NK cell inhibitory receptor Ly49A engagement on T cells dramatically limits T-cell activation and the resultant lymphoproliferative disorder that occurs in CTLA-4-deficient mice. Prevention of activation and expansion of the potentially autoreactive CTLA-4(-/-) T cells by the Ly49A-mediated inhibitory signal demonstrates that NKR expression can play an important regulatory role in T-cell homeostasis in vivo. These results demonstrate the importance of inhibitory signals in T-cell homeostasis and suggest the common biochemical basis of inhibitory signaling pathways in T lymphocytes

My funky genetics : BRCA1/2 mutation carriers\u27 understanding of genetic inheritance and reproductive merger in the context of new reprogenetic technologies

Deleterious mutations in the BRCA1/BRCA2 genes elevate lifetime risk of breast and ovarian cancer. Each child of a mutation-positive parent has a 50% chance of inheriting it. Preimplantation genetic diagnosis (PGD) permits prospective parents to avoid the birth of a BRCA-mutation-positive child, introducing predictability into a process historically defined by chance. This investigation explored how BRCA1/2 mutation carriers understand genetic inheritance and consider a child\u27s inheritance of a BRCA1/2 mutation, given the opportunities that exist to pursue PGD. Thirty-nine female and male BRCA1/2 mutation carriers of reproductive age were recruited from urban cancer and reproductive medical centers. Participants completed a standardized educational presentation on PGD and prenatal diagnosis, with pre-and posttest assessments. An interdisciplinary team of qualitative researchers analyzed data using grounded theory techniques. Participants expressed the belief that reproduction yields children with unique genetic strengths and challenges, including the BRCA1/2 mutation, family traits for which predictive tests do not exist, and hypothetical genetic risks. Participants expressed preference for biologically related children, yet stated their genetically well partner\u27s lineage would be marred through reproductive merger, requiring the well partner to assume the burden of the BRCA1/2 mutation via their children. Participants expressed diverse views of genetically well partners\u27 participation in family planning and risk management decisions. Pressure to use reprogenetic technology may grow as genetic susceptibility testing becomes more widely available. Work with individuals and couples across the disease spectrum must be attuned to the ways beliefs about genetic inheritance play into reproductive decision-making. (PsycINFO Database Record (c) 2012 APA, all rights reserved) © 2012 American Psychological Association

Quadriceps and gluteus medius activation with increasing task speed during a lateral step-down

Clinically, slower task performance is thought to increase task demands. Interestingly, few studies have explored altering task rate on electromyographic (EMG) muscle activity, particularly in the lower extremity.https://ecommons.udayton.edu/dpt_symposium/1034/thumbnail.jp

Allometry and developmental integration of body growth in a piranha, Pygocentrus nattereri (Teleostei: Ostariophysi)

Piranhas, like many teleosts, change their diets on both ontogenetic and phylogenetic time scales. Prior studies have suggested that pervasive morphological changes in body form on a phylogenetic time scale may be related to changes in diet, but previous reports have found little shape change in piranhas on an ontogenetic time scale. We re-examine the post-transformational allometry of body form in one piranha, Pygocentrus nattereri (Kner), using the method of thin-plate splines decomposed by their partial warps. We find substantial evidence of allometry, primarily elongation of the mid-body relative to the more anterior and posterior regions, elongation of the postorbital and nape regions relative to the more anterior head and posterior body, and deepening of the head relative to the body. In addition to these pervasive changes throughout the body, there are some that are more localized, especially elongation of the postorbital region relative to eye diameter and snout, and an even more localized elongation of the snout relative to eye diameter. Initial dietary transitions are associated with changes in head and jaw proportions, but rates of shape change decelerate through growth, so that the final transition to a diet increasingly dominated by small whole fish appears associated with change largely in overall body size. © 1995 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50288/1/1052230309_ftp.pd

Identification Of Novel α4β2-Nicotinic Acetylcholine Receptor (Nachr) Agonists Based On An Isoxazole Ether Scaffold That Demonstrate Antidepressant-Like Activity

There is considerable evidence to support the hypothesis that the blockade of nAChR is responsible for the antidepressant action of nicotinic ligands. The nicotinic acetylcholine receptor (nAChR) antagonist, mecamylamine, has been shown to be an effective add-on in patients that do not respond to selective serotonin reuptake inhibitors. This suggests that nAChR ligands may address an unmet clinical need by providing relief from depressive symptoms in refractory patients. In this study, a new series of nAChR ligands based on an isoxazole-ether scaffold have been designed and synthesized for binding and functional assays. Preliminary structure-activity relationship (SAR) efforts identified a lead compound 43, which possesses potent antidepressant-like activity (1 mg/kg, IP; 5 mg/kg, PO) in the classical mouse forced swim test. Early stage absorption, distribution, metabolism, excretion, and toxicity (ADME-Tox) studies also suggested favorable drug-like properties, and broad screening toward other common neurotransmitter receptors indicated that compound 43 is highly selective for nAChRs over the other 45 neurotransmitter receptors and transporters tested. © 2011 American Chemical Society

16S rRNA Amplicon Sequencing of Urban Prokaryotic Communities in the South Bronx River Estuary

Biodiversity monitoring is an essential component of restoration efforts. We sequenced 16S rRNA gene amplicons from sediments and waters of Hunts Point Riverside Park and Soundview Park, located in a historically degraded but recovering urban estuary in New York. In total, 16,165 unique amplicon sequence variants were recovered, and Proteobacteria was the dominant phylum

16S rRNA Amplicon Sequencing of Urban Prokaryotic Communities in the South Bronx River Estuary

Biodiversity monitoring is an essential component of restoration efforts. We sequenced 16S rRNA gene amplicons from sediments and waters of Hunts Point Riverside Park and Soundview Park, located in a historically degraded but recovering urban estuary in New York. In total, 16,165 unique amplicon sequence variants were recovered, and Proteobacteria was the dominant phylum

Adherence in the treatment of patients with extensively drug-resistant tuberculosis and HIV in South Africa: a prospective cohort study.

CAPRISA, 2014.Abstract available in pdf