Developing and Implementing Self-Direction Programs and Policies: A Handbook

Provides a guide to designing, implementing, and evaluating service delivery models that allow public program participants to manage their own care services and supports. Outlines elements of employer and budget authorities, enrollment, and counseling

The Adoption and Use of Health Information Technology by Community Health Centers, 2009-2013

With help from targeted federal investments, U.S. physician offices and hospitals have accelerated their adoption and use of patient electronic health records (EHRs) and other health information technology (HIT) in recent years. Comparison of results from. The Commonwealth Fund's two national surveys of federally qualified health centers (FQHCs) in 2009 and 2013 show that HIT adoption has also grown substantially for these important providers of care in poor and underserved communities. Nearly all surveyed FQHCs (93%) now have an EHR system, a 133 percent increase from 2009, the year federal "meaningful use" incentives for HIT were first authorized. Three-quarters of health centers (76%) reported meeting the criteria to qualify for incentive payments. Remaining challenges for health centers include achieving greater interoperability of EHR systems and ensuring patient access to their records. Mobile technology, such as text messaging, may help FQHCs further expand patient outreach and access to care

Ready or Not? How Community Health Centers View Their Preparedness to Care for Newly Insured Patients

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), an important source of care in low-income communities. A Commonwealth Fund survey asked health center leaders in 2013 about current and anticipated workforce challenges, as well as efforts under way to prepare for the increase in patients. The majority of FQHCs reported shortages of primary care doctors (56%), especially bilingual physicians (60%). Health centers are engaged in activities to meet the needs of new patients, with 53 percent pursuing integration of behavioral health and 31 percent hiring additional clinical staff. To help them provide quality care to more patients, FQHCs will require assistance to recruit additional personnel, particularly bilingual staff and mental health professionals, and to expand access to care through telehealth and other strategies

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

The TESS Objects of Interest Catalog from the TESS Prime Mission

We present 2241 exoplanet candidates identified with data from the Transiting Exoplanet Survey Satellite (TESS) during its 2 yr Prime Mission. We list these candidates in the TESS Objects of Interest (TOI) Catalog, which includes both new planet candidates found by TESS and previously known planets recovered by TESS observations. We describe the process used to identify TOIs, investigate the characteristics of the new planet candidates, and discuss some notable TESS planet discoveries. The TOI catalog includes an unprecedented number of small planet candidates around nearby bright stars, which are well suited for detailed follow-up observations. The TESS data products for the Prime Mission (sectors 1-26), including the TOI catalog, light curves, full-frame images, and target pixel files, are publicly available at the Mikulski Archive for Space Telescopes

Safety and tolerability of lacosamide as adjunctive therapy for adults with partial-onset seizures: Analysis of data pooled from three randomized, double-blind, placebo-controlled clinical trials

AbstractObjectiveThe objective of this study was to describe a priori protocol-defined analyses to evaluate the safety and tolerability of adjunctive oral lacosamide (200–600mg/day) in adults (ages 16–70years) with partial-onset seizures (POS) using data pooled from three similarly designed randomized, double-blind, placebo-controlled trials (SP667, SP754 [NCT00136019], SP755 [NCT00220415]).MethodsPatients with POS (≥2years' duration, ≥2 previous antiepileptic drugs [AEDs]) uncontrolled by a stable dosing regimen of 1–3 concomitant AEDs were randomized to treatment with lacosamide at doses of 200mg/day, 400mg/day, or 600mg/day, or placebo. Studies comprised a 4- to 6-week titration phase to target dose followed by a 12-week maintenance phase. Safety outcomes included treatment-emergent adverse events (TEAEs) of particular relevance to patients with POS, overall TEAEs, and discontinuations due to TEAEs. Post hoc analyses included evaluation of TEAEs potentially related to cognition and TEAEs leading to discontinuation analyzed by concomitant AEDs.ResultsOne thousand three hundred eight patients were randomized to and received treatment; 944 to lacosamide and 364 to placebo. Most patients (84.4%) were taking 2 or 3 concomitant AEDs. The most common drug-associated TEAEs (reported by ≥5% of patients in any lacosamide dose group and with an incidence at least twice that reported for placebo during the treatment phase) were dizziness (30.6% for lacosamide vs 8.2% for placebo), nausea (11.4% vs 4.4%), and diplopia (10.5% vs 1.9%). Common drug-associated TEAEs generally appeared to be dose-related, and the incidence of each was lower during the 12-week maintenance phase than during the titration phase. Most TEAEs were either mild or moderate in intensity; severe TEAEs were predominantly observed with lacosamide 600mg/day. No individual serious TEAE occurred in ≥1% of all lacosamide-treated patients. Treatment-emergent adverse events led to discontinuation in 8.1%, 17.2%, and 28.6% of the lacosamide 200-, 400-, and 600-mg/day groups, respectively (vs 4.9% of placebo). Few TEAEs were related to rash, weight loss/gain, changes in clinical chemistry parameters, or psychiatric disturbances, or were seizure-related. The odds of reporting any potential cognition-related TEAE vs placebo increased with dose and were similar between lacosamide doses of 200 and 400mg/day and placebo (odds ratio 1.3, 95% confidence interval 0.7–2.4). Discontinuations due to TEAEs based on most commonly used AEDs taken in combination with lacosamide (all doses combined) were carbamazepine (15.3% [51/334] vs 3.9% [5/129] placebo), lamotrigine (19.2% [56/291] vs 4.3% [5/117]), and levetiracetam (10.1% [28/278] vs 3.9% [4/103]).ConclusionsThe safety and tolerability profile of adjunctive lacosamide in this detailed evaluation was similar to that observed in the individual double-blind trials. Adjunctive lacosamide was associated with TEAEs related to the nervous system and gastrointestinal tract, predominantly during titration