Proposed Work Requirements in Pennsylvania Medicaid: Characterizing Eligible Beneficiaries

Using information from all 2.9 million Pennsylvania Medicaid enrollees as of April 1, 2016, we identified the 815,763 working-age adults (ages 21-64) and assessed their likely exemption and working status over the course of the subsequent year. More than half would likely be exempt from work requirements because of their caregiver status (38%) or disability status (14%). Thirty-one percent would be nonexempt but considered working, with at least one month of work; this group had either part-time or full time work 95% of the time they were enrolled in Medicaid. This snapshot suggests that more than 80% of working-age adults were already working or disabled or potential caregivers and thus, while still subject to compliance verification that the Department will need to administer and enforce, are unlikely to substantially benefit from work requirements. Our results, as visualized below, show that 11% (90,194) of working-age enrollees (815,763) subject to administration and verification of the work requirement program would be found to be nonexempt, not working and on Medicaid for at least a year. This group, representing just 3% of the 2.9 million Medicaid enrollees, would have the greatest potential to change their work status as a result of the program. The burden and cost of implementation to the 815,763 would have to be weighed against the benefit to the 90,194 to determine whether, among current beneficiaries, the benefits of such a program outweigh the costs

Contemporary national trends of cystic fibrosis hospitalizations and co-morbidities in the United States

  INTRODUCTION: Cystic fibrosis (CF) is a life-limiting multisystemic genetic disease. Patients with CF have a high rate of hospitalization. We attempt to ascertain national trends of inpatient stays, prevalence of various co-morbidities during hospitalizations, outcomes and discharge disposition among CF patients. MATERIAL AND METHODS: Data from the National Inpatient Sample (NIS) was used to identify all hospitalizations of patients with CF and their demographic characteristics from 2003 to 2013. Prevalence and effects of various co-morbidities like acute kidney injury (AKI) were determined. Detailed sub-group analysis was performed for individuals with lung transplant. RESULTS: The annual rate of hospitalization per 1,000 CF patients in the U.S. increased from 994 in 2003 to 1,072 in 2013. The overall in-hospital mortality was 1.5%; median age at death was 27 years. In-hospital mortality trended down from 1.9% to 1.2% from 2003 to 2013 (p-value for trend: 0.002). The median length of stay was 7 days. The prevalence of chronic liver disease and AKI was 3.7% and 3.8% respectively. Multivariate adjusted odds of mortality for AKI was 1.74 (95% CI 1.57−1.93, p < 0.001). Patients with prior lung transplantation accounted for 6.5% of hospitalizations. These patients had a significantly higher prevalence of AKI. CONCLUSIONS: The annual hospitalization rates of CF patients is increasing over the years. Females with CF constitute a higher proportion of hospitalized patients despite a higher male preponderance of males with CF in the community. AKI is associated with a significantly higher in-hospital mortality. Lung transplant recipients have a higher prevalence of AKI and mortality.

Współczesne trendy dotyczące hospitalizacji i chorób współistniejących u chorych na mukowiscydozę w Stanach Zjednoczonych

WSTĘP: Mukowiscydoza jest genetycznie uwarunkowaną wielonarządową chorobą, która negatywnie wpływa na długość życia. Chorzy na mukowiscydozę wymagają częstych hospitalizacji. W prezentowanej pracy podjęto próbę oceny trendów dotyczących hospitalizacji chorych na mukowiscydozę, występowania chorób współistniejących, wyników leczenia i zaleceń w chwili wypisu ze szpitala. MATERIAŁ I METODY: Użyto danych krajowego rejestru hospitalizacji (National Inpatient Sample) w celu identyfikacji wszystkich przypadków oraz cech demograficznych chorych na mukowiscydozę hospitalizowanych w okresie 2003–2013. Oceniono występowanie współchorobowości, takich jak ostre uszkodzenie nerek (AKI, acute kidney injury) oraz ich wpływ na przebieg choroby. Dokonano szczegółowej analizy podgrupy chorych po przeszczepieniu płuca. WYNIKI: Roczna częstość hospitalizacji na 1000 chorych na mukowiscydozę w Stanach Zjednoczonych wzrosła z 994 w 2003 roku do 1072 w roku 2013. Ogólna śmiertelność wewnątrzszpitalna wynosiła 1,5%, a mediana wieku w chwili zgonu — 27 lat. Śmiertelność wewnątrzszpitalna wykazywała trend spadkowy z 1,9% w roku 2003 do 1,2% w 2013 roku (wartość p dla trendu: 0,002). Mediana długości pobytu w szpitalu wynosiła 7 dni. Przewlekła choroba wątroby i ostre uszkodzenie nerek występowały odpowiednio z częstością 3,7% i 3,8%. Wieloczynnikowy skorygowany iloraz szans dla śmiertelności w AKI wynosił 1,74 (95% CI 1,57−1,93, p < 0,001). Pacjenci po przebytej transplantacji płuca stanowili 6,5% wszystkich hospitalizacji. U tych chorych stwierdzono znamiennie wyższe ryzyko rozwoju ostrego uszkodzenia nerek. WNIOSKI: Wskaźniki rocznej hospitalizacji chorych na mukowiscydozę rosną z każdym rokiem. Kobiety stanowią większość chorych hospitalizowanych, pomimo przewagi mężczyzn w populacji wszystkich chorych na mukowiscydozę. Występowanie AKI wiąże się z większą śmiertelnością podczas hospitalizacji.WSTĘP: Mukowiscydoza jest genetycznie uwarunkowaną wielonarządową chorobą, która negatywnie wpływa na długość życia. Chorzy na mukowiscydozę wymagają częstych hospitalizacji. W prezentowanej pracy podjęto próbę oceny trendów dotyczących hospitalizacji chorych na mukowiscydozę, występowania chorób współistniejących, wyników leczenia i zaleceń w chwili wypisu ze szpitala. MATERIAŁ I METODY: Użyto danych krajowego rejestru hospitalizacji (National Inpatient Sample) w celu identyfikacji wszystkich przypadków oraz cech demograficznych chorych na mukowiscydozę hospitalizowanych w okresie 2003–2013. Oceniono występowanie współchorobowości, takich jak ostre uszkodzenie nerek (AKI, acute kidney injury) oraz ich wpływ na przebieg choroby. Dokonano szczegółowej analizy podgrupy chorych po przeszczepieniu płuca. WYNIKI: Roczna częstość hospitalizacji na 1000 chorych na mukowiscydozę w Stanach Zjednoczonych wzrosła z 994 w 2003 roku do 1072 w roku 2013. Ogólna śmiertelność wewnątrzszpitalna wynosiła 1,5%, a mediana wieku w chwili zgonu — 27 lat. Śmiertelność wewnątrzszpitalna wykazywała trend spadkowy z 1,9% w roku 2003 do 1,2% w 2013 roku (wartość p dla trendu: 0,002). Mediana długości pobytu w szpitalu wynosiła 7 dni. Przewlekła choroba wątroby i ostre uszkodzenie nerek występowały odpowiednio z częstością 3,7% i 3,8%. Wieloczynnikowy skorygowany iloraz szans dla śmiertelności w AKI wynosił 1,74 (95% CI 1,57−1,93, p < 0,001). Pacjenci po przebytej transplantacji płuca stanowili 6,5% wszystkich hospitalizacji. U tych chorych stwierdzono znamiennie wyższe ryzyko rozwoju ostrego uszkodzenia nerek. WNIOSKI: Wskaźniki rocznej hospitalizacji chorych na mukowiscydozę rosną z każdym rokiem. Kobiety stanowią większość chorych hospitalizowanych, pomimo przewagi mężczyzn w populacji wszystkich chorych na mukowiscydozę. Występowanie AKI wiąże się z większą śmiertelnością podczas hospitalizacji

Ultrasound mediated synthesis of aldimines from non-enolizable aldehydes at room temperature

1593-1600user-friendly, energy efficient method of synthesizing N-sulfonyl aldimines at room temperature (25‒28°C) from readily available and inexpensive reagents has been developed. The method employs ultrasonication from common laboratory ultrasonic cleaner to mediate the reaction. FeCl3 as catalyst and molecular sieves as water scavenger have produced excellent yields of aldimines with short reaction time. The reaction set-up does not require inert atmosphere or anhydrous solvent thereby saving resources and time. The easily scalable method works well for the condensation of aromatic non-enolizable aldehydes and sulfonamides

Liver X receptor inhibition potentiates mitotane induced adrenotoxicity in ACC

Adrenocortical carcinoma (ACC) is a rare aggressive malignancy with a poor outcome largely due to limited treatment options. Here, we propose a novel therapeutic approach through modulating intracellular free cholesterol via the liver X receptor alpha (LXRα) in combination with current first line pharmacotherapy, mitotane. H295R and MUC-1 ACC cell lines were pretreated with LXRα inhibitors in combination with mitotane. In H295R, mitotane (20, 40, 50µM) induced dose-dependent cell death, however, in MUC-1 this only occurred at a supratherapeutic concentration (200µM). LXRα inhibition potentiated mitotane-induced cytotoxicity in both cell lines. This was confirmed through use of the CompuSyn model which showed moderate pharmacological synergism and was indicative of apoptotic cell death via an increase in annexinV and cleaved-caspase 3 expression. Inhibition of LXRα was confirmed through downregulation of cholesterol efflux pumps ABCA1 and ABCG1, however, combination treatment with mitotane attenuated this effect. Intracellular free cholesterol levels were associated with increased cytotoxicity in H295R (r2=0.5210) and MUC-1 (r2=0.9299) cells. While both cell lines exhibited similar levels of free cholesterol at baseline, H295R were cholesterol ester rich whereas MUC-1 were cholesterol ester poor. We highlight the importance of LXRα mediated cholesterol metabolism in the management of ACC, drawing attention to its role in the therapeutics of mitotane sensitive tumours. We also demonstrate significant differences in cholesterol storage between mitotane sensitive and resistant disease.</jats:p

Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program

Importance: Limited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation. Objective: To evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people. Design, setting, and participants: This cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility. Exposures: Self-identified gender identity and sexual orientation group. Main outcomes and measures: Twelve health conditions were evaluated: 11 using EHR data and 1, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), using participants' physical measurements. Logistic regression (adjusting for age, income, and employment, enrollment year, and US Census division) was used to obtain adjusted odds ratios (AORs) for the associations between each SGM group and health condition compared with a non-SGM reference group. Results: The analytic sample included 346 868 participants (median [IQR] age, 55 [39-68] years; 30 763 [8.9%] self-identified as SGM). Among participants with available BMI (80.2%) and EHR data (69.4%), SGM groups had higher odds of anxiety, depression, HIV diagnosis, and tobacco use disorder but lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension. Estimated associations for asthma (AOR, 0.39 [95% CI, 0.24-0.63] for gender diverse people assigned male at birth; AOR, 0.51 [95% CI, 0.38-0.69] for transgender women), a BMI of 25 or higher (AOR, 1.65 [95% CI, 1.38-1.96] for transgender men), cancer (AOR, 1.15 [95% CI, 1.07-1.23] for cisgender sexual minority men; AOR, 0.88 [95% CI, 0.81-0.95] for cisgender sexual minority women), and substance use disorder (AOR, 0.35 [95% CI, 0.24-0.52] for gender diverse people assigned female at birth; AOR, 0.65 [95% CI, 0.49-0.87] for transgender men) varied substantially across SGM groups compared with non-SGM groups. Conclusions and relevance: In this cross-sectional analysis of data from the All of Us Research Program, SGM participants experienced health inequities that varied by group and condition. The All of Us Research Program can be a valuable resource for conducting health research focused on SGM people.</p

A measurement of the millimetre emission and the Sunyaev-Zel'dovich effect associated with low-frequency radio sources

We present a statistical analysis of the millimetre-wavelength properties of 1.4GHz-selected sources and a detection of the Sunyaev–Zel’dovich (SZ) effect associated with the haloes that host them. We stack data at 148, 218 and 277GHz from the Atacama Cosmology Telescope at the positions of a large sample of radio AGN selected at 1.4GHz. The thermal SZ effect associated with the haloes that host the AGN is detected at the 5σ level through its spectral signature, representing a statistical detection of the SZ effect in some of the lowest mass haloes (average M 200 ≈ 10 13 M. h −1 70 ) studied to date. The relation between the SZ effect and mass (based on weak lensing measurements of radio galaxies) is consistent with that measured by Planck for local bright galaxies. In the context of galaxy evolution models, this study confirms that galaxies with radio AGN also typically support hot gaseous haloes. Adding Herschel observations allows us to show that the SZ signal is not significantly contaminated by dust emission. Finally, we analyse the contribution of radio sources to the angular power spectrum of the cosmic microwave background

Regulation of Organelle Acidity

Intracellular organelles have characteristic pH ranges that are set and maintained by a balance between ion pumps, leaks, and internal ionic equilibria. Previously, a thermodynamic study by Rybak et al. (Rybak, S., F. Lanni, and R. Murphy. 1997. Biophys. J. 73:674–687) identified the key elements involved in pH regulation; however, recent experiments show that cellular compartments are not in thermodynamic equilibrium. We present here a nonequilibrium model of lumenal acidification based on the interplay of ion pumps and channels, the physical properties of the lumenal matrix, and the organelle geometry. The model successfully predicts experimentally measured steady-state and transient pH values and membrane potentials. We conclude that morphological differences among organelles are insufficient to explain the wide range of pHs present in the cell. Using sensitivity analysis, we quantified the influence of pH regulatory elements on the dynamics of acidification. We found that V-ATPase proton pump and proton leak densities are the two parameters that most strongly influence resting pH. Additionally, we modeled the pH response of the Golgi complex to varying external solutions, and our findings suggest that the membrane is permeable to more than one dominant counter ion. From this data, we determined a Golgi complex proton permeability of 8.1 × 10−6 cm/s. Furthermore, we analyzed the early-to-late transition in the endosomal pathway where Na,K-ATPases have been shown to limit acidification by an entire pH unit. Our model supports the role of the Na,K-ATPase in regulating endosomal pH by affecting the membrane potential. However, experimental data can only be reproduced by (1) positing the existence of a hypothetical voltage-gated chloride channel or (2) that newly formed vesicles have especially high potassium concentrations and small chloride conductance