Essential Health Benefits: 50-State Variations on a Theme

All qualified health plans under the Affordable Care Act must cover a package of essential health benefits (EHBs) equal in scope to a typical employer plan. The law laid out 10 general categories of services that EHBs must cover, but did not itemize those services. Each state is allowed to identify an existing plan as a benchmark for these EHBs. The result of this policy is that EHBs vary from state to state, often because of a legacy of different state-mandated benefits (such as treatments for autism, infertility, or temporomandibular joint disorders). This Data Brief analyzes state variation in coverage and limits for these non-uniform benefits

Characterizing G-quadruplexes, a novel regulatory element, in Streptomyces bacteria

Less is known about the mechanisms that govern gene regulation in GC-rich bacteria than in the more AT-rich model organisms like Escherichia coli and Bacillus subtilis. G-quadruplexes (GQs) are stable structures that form in G-rich nucleic acid sequences, and have the potential to be important regulators of gene expression – particularly in GC-rich organisms. Streptomyces are extremely GC-rich bacteria with the capacity to produce a vast range of antibiotic compounds. There are still many gaps in our understanding of gene regulation in these bacteria, and yet GQ sequences have never been investigated for their regulatory potential in Streptomyces, even though they are known to play important roles in various eukaryotic systems. Here, we performed an in-depth in silico analysis of the S. venezuelae genome and found an abundance of GQ sequences in these genomes. We discovered that these sequences were enriched in putative regulatory regions and in antibiotic biosynthetic clusters. We followed up this in silico analysis with reporter assays that demonstrated that GQ sequences affected gene expression in Streptomyces. We also took steps towards elucidating the mechanism of action for an observed increase in reporter activity in the presence of the GQ sequence. Finally, we discovered two proteins, SVEN_2656 and SVEN_3866, with the potential to interact with GQ sequences and may function in preventing adverse effects of GQ structures. These results indicate that GQs have the potential to act as important regulators of gene expression in Streptomyces bacteria, and future work on these systems could lead to a broader understanding of gene regulation in all bacteria, and in Streptomyces specifically, could be employed to stimulate antibiotic production.ThesisMaster of Science (MSc

Health Insurance Marketplace Enrollment Rates by Type of Exchange

Because the ACA gave them choices in how to implement insurance coverage, health reform looks different state to state. This Data Brief examines a number of choices related to the establishment and running of the new health insurance marketplaces, and their potential impact on enrollment rates to date. We use existing data sources as well as a new database developed by researchers at the University of Pennsylvania that documents and codes state-level variation in the political setting, institutional structures, and operational decisions likely to affect outcomes on the marketplaces

Final Enrollment Rates Show Federally run Marketplaces Make up Lost Ground at end of Enrollment

This new data brief updates our interim March 2014 findings with enrollment rates at the close of the Affordable Care Act\u27s first open enrollment period. It focuses on enrollment rates by state and type of marketplace, and assesses changes in enrollment rates in the final six weeks. The final enrollment figures reveal that the federally facilitated marketplaces and some of the troubled state-based ones made up some ground in the last four to six weeks of the open enrollment period

State-Based Marketplaces Spent Heavily to Help Enroll Consumers

The Affordable Care Act required that consumers have access to in-person or on-call assistance to understand their choices and navigate the complexities of the new health insurance marketplaces. One consequence of each state\u27s decision about whether to run its own marketplace is an extreme variation in the time-limited funding available for consumer assistance programs. This Data Brief looks at the types of assistance available and the level of funding for each state in the first year of marketplace operations

Cell-wall synthesis and ribosome maturation are co-regulated by an RNA switch in Mycobacterium tuberculosis

The success of Mycobacterium tuberculosis relies on the ability to switch between active growth and non-replicating persistence, associated with latent TB infection. Resuscitation promoting factors (Rpfs) are essential for the transition between these states. Rpf expression is tightly regulated as these enzymes are able to degrade the cell wall, and hence potentially lethal to the bacterium itself. We have identified a regulatory element in the 5' untranslated region (UTR) of rpfB. We demonstrate that this element is a transcriptionally regulated RNA switch/riboswitch candidate, which appears to be restricted to pathogenic mycobacteria, suggesting a role in virulence. We have used translation start site mapping to re-annotate the RpfB start codon and identified and validated a ribosome binding site that is likely to be targeted by an rpfB antisense RNA. Finally, we show that rpfB is co-transcribed with ksgA and ispE downstream. ksgA encodes a universally conserved methyltransferase involved in ribosome maturation and ispE encodes an essential kinase involved in cell wall synthesis. This arrangement implies co-regulation of resuscitation, cell wall synthesis and ribosome maturation via the RNA switch

Neurological features of COVID-19 infection: A case series of geriatric patients

The coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which is responsible for the coronavirus disease 2019 (COVID-19), is known to cause substantial pulmonary disease. However, clinicians observed many extrapulmonary manifestations of COVID-19. Neurological manifestations are being recognised increasingly. On the basis of knowledge of other coronaviruses, especially those that caused the severe acute respiratory syndrome and Middle East respiratory syndrome epidemics, cases of central nervous system disease caused by SARS-CoV-2 might be expected to be rare. We report four cases of neurologic manifestations of SARS-CoV-2 in elderly patients who presented to the Geriatric Department of Pescara Hospital (Italy)

Could ischemic colitis be the first manifestation of COVID-19? A case report

We report on a case of SARS-CoV-2-infected patient with clinical and histologic features mimicking ischaemic colitis. This case provides evidence that SARS-CoV-2 may compromise the microvascular blood flow in the intestinal wall, with a parallel activation of the inflammatory cascade, either in the absence, or earlier of any pulmonary involvement

Neurological features of COVID-19 infection: A case series of geriatric patients

The coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which is responsible for the coronavirus disease 2019 (COVID-19), is known to cause substantial pulmonary disease. However, clinicians observed many extrapulmonary manifestations of COVID-19. Neurological manifestations are being recognised increasingly. On the basis of knowledge of other coronaviruses, especially those that caused the severe acute respiratory syndrome and Middle East respiratory syndrome epidemics, cases of central nervous system disease caused by SARS-CoV-2 might be expected to be rare. We report four cases of neurologic manifestations of SARS-CoV-2 in elderly patients who presented to the Geriatric Department of Pescara Hospital (Italy)

Could ischemic colitis be the first manifestation of COVID-19? A case report

We report on a case of SARS-CoV-2-infected patient with clinical and histologic features mimicking ischaemic colitis. This case provides evidence that SARS-CoV-2 may compromise the microvascular blood flow in the intestinal wall, with a parallel activation of the inflammatory cascade, either in the absence, or earlier of any pulmonary involvement