Pacing Ourselves: Saving Medicaid through Programs of All-Inclusive Care for the Elderly

The baby boomer generation is aging, and those in the boomer generation will soon pose an unparalleled burden on government-subsidized health care systems like Medicaid. To sustain this impending burden, these systems must undergo significant reform. Most elderly individuals require long-term care at some point in their lives. Today, many baby boomers are providing this care to their elderly parents, and this practice has kept most of the elderly in need of care at home and out of long-term care facilities. As the baby boomers age, though, they will have fewer family members available to care for them and will depend on outside sources for care. Furthermore, the baby boomers will depend on Medicaid to pay for this care. However, this health care system is already strained, even with the current trend of family caregivers. Fortunately, one health care program could lighten this oncoming burden: Programs of All-Inclusive Care for the Elderly (PACE). Through PACE, patients can remain at home and in their communities while receiving care from an interdisciplinary team of professionals. Regulations controlling PACE demand high-quality care, and operating PACE organizations have experienced positive outcomes. Because of the cost benefits of home- and community-based care, states that have enacted PACE have also saved on health care costs. Current PACE regulations allow states to optionally offer PACE through Medicaid. However, the high start-up costs of opening new PACE centers deter the program’s expansion. This Comment will advocate for the federal government to subsidize these start-up costs. Subsidizing start-up costs will expand PACE through Medicaid, effectively reaching PACE’s target audience. By expanding PACE, elderly citizens will enjoy the benefits of the program, and the federal government will reap the cost savings. This solution will relieve the strain on Medicaid while supporting the baby boomers’ looming long-term care needs

Solution Focused Financial Therapy: A Brief Report of a Pilot Study

The financial counseling, financial planning, and financial therapy fields are hampered by a conceptual and empirical paucity of clinical and experimental evidence-based research. In an attempt to decrease this gap in the literature, a pilot study was developed to test the implementation of a solution-focused financial therapy client intervention approach, in which solution-focused therapy techniques were applied in a financial counseling setting. This paper reports findings from a clinical intervention study of college students (N = 8) who presented a variety of financial issues related to budgeting, investing, and debt repayment problems. Data were gathered prior to the start of treatment, after treatment ended, and three months later. Participants’ psychological well-being and financial behaviors improved, while financial distress decreased. The solution-focused financial therapy approach used is discussed

Safety and Pharmacokinetics of Motesanib in Combination with Panitumumab and Gemcitabine-Cisplatin in Patients with Advanced Cancer

Purpose. The aim of this study was to assess the safety and tolerability of motesanib (an orally administered small-molecule antagonist of vascular endothelial growth factor receptors 1, 2, and 3, platelet-derived growth factor receptor, and Kit) when administered in combination with panitumumab, gemcitabine, and cisplatin. Methods. This was an open-label, multicenter phase 1b study in patients with advanced solid tumors with an ECOG performance status ≤1 and for whom a gemcitabine/cisplatin regimen was indicated. Patients received motesanib (0 mg [control], 50 mg once daily [QD], 75 mg QD, 100 mg QD, 125 mg QD, or 75 mg twice daily [BID]) with panitumumab (9 mg/kg), gemcitabine (1250 mg/m2) and cisplatin (75 mg/m2) in 21-day cycles. The primary endpoint was the incidence of dose-limiting toxicities (DLTs). Results. Forty-one patients were enrolled and received treatment (including 8 control patients). One of eight patients in the 50 mg QD cohort and 5/11 patients in the 125 mg QD cohort experienced DLTs. The maximum tolerated dose was established as 100 mg QD. Among patients who received motesanib (n = 33), 29 had motesanib-related adverse events. Fourteen patients had serious motesanib-related events. Ten patients had motesanib-related venous thromboembolic events and three had motesanib-related arterial thromboembolic events, two of which were considered serious. One patient had a complete response and nine had partial responses as their best objective response. Conclusions. The combination of motesanib, panitumumab, and gemcitabine/cisplatin could not be administered consistently and, at the described doses and schedule, may be intolerable. However, encouraging antitumor activity was noted in some cases

Solution Focused Financial Therapy: A Brief Report of a Pilot Study

The financial counseling, financial planning, and financial therapy fields are hampered by a conceptual and empirical paucity of clinical and experimental evidence-based research. In an attempt to decrease this gap in the literature, a pilot study was developed to test the implementation of a solution-focused financial therapy client intervention approach, in which solution-focused therapy techniques were applied in a financial counseling setting. This paper reports findings from a clinical intervention study of college students (N = 8) who presented a variety of financial issues related to budgeting, investing, and debt repayment problems. Data were gathered prior to the start of treatment, after treatment ended, and three months later. Participants’ psychological well-being and financial behaviors improved, while financial distress decreased. The solution-focused financial therapy approach used is discussed

Effect of dehydration on the inactivation of Listeria monocytogenes and Salmonella enterica on enoki and wood ear mushrooms

Foodborne illness outbreaks in the U.S. associated with consumption of both fresh and dried specialty mushrooms have recently occurred. Dried wood ear mushrooms were implicated in a salmonellosis outbreak in 2020, while fresh enoki mushrooms were associated with two listeriosis outbreaks in 2020 and 2023. These specialty mushrooms are commercially available in both their fresh and dried states. Due to the short shelf life of mushrooms, dehydration is a common method used in both industry and by consumers to extend the shelf life and preserve quality. Therefore, the aim of this study was to evaluate the use of dehydration on the inactivation kinetics of both Listeria monocytogenes and Salmonella enterica on enoki and wood ear mushrooms. Fresh mushrooms were inoculated with four strain cocktails of either L. monocytogenes or S. enterica and dried at ambient conditions for 10 min. Following drying of the inoculum, mushrooms were placed into food dehydrators preheated to 70, 80, or 90°C and treated for up to 24 h. At treatment intervals, mushrooms were removed from the dehydrators for pathogen enumeration. Inactivation kinetics for both pathogens were modeled using the Weibull, log-linear with tail, and log-linear with shoulder models. Pathogen reductions of >4 log CFU/g were achieved on both enoki and wood ear mushrooms during dehydration at 90°C after only 2–4 h. At 70 and 80°C, log reductions of >4 log CFU/g were observed on wood ear mushrooms after 4–8 h. On enoki mushrooms, a tailing effect was observed with residual populations (>2 log CFU/g) of L. monocytogenes and S. enterica remaining even after 24 h of treatment at both 70 and 80°C. This study emphasizes the need for an individualized dehydration strategy for each mushroom type to ensure the effectiveness of dehydration as a process to reduce pathogen populations. Results of this study will aid in informing proper time and temperature combinations for dehydration of specialty mushrooms to ensure product safety

UNBOUND

Unbound showcases the graduating class from the fashion design school at Fanshawe College. Unbound describes the creative spirit and achievements of our twenty-seven emerging Canadian fashion designers. Unbound 2014 is a professional collaboration between Fanshawe College, Community and Professionals in the Fashion Industry. As you turn the pages, admire their accomplishments - the results of three years of passion, hard work, and dedication.https://first.fanshawec.ca/famd_design_fashiondesign_unbound/1003/thumbnail.jp

The genomes of two key bumblebee species with primitive eusocial organization

Background: The shift from solitary to social behavior is one of the major evolutionary transitions. Primitively eusocial bumblebees are uniquely placed to illuminate the evolution of highly eusocial insect societies. Bumblebees are also invaluable natural and agricultural pollinators, and there is widespread concern over recent population declines in some species. High-quality genomic data will inform key aspects of bumblebee biology, including susceptibility to implicated population viability threats. Results: We report the high quality draft genome sequences of Bombus terrestris and Bombus impatiens, two ecologically dominant bumblebees and widely utilized study species. Comparing these new genomes to those of the highly eusocial honeybee Apis mellifera and other Hymenoptera, we identify deeply conserved similarities, as well as novelties key to the biology of these organisms. Some honeybee genome features thought to underpin advanced eusociality are also present in bumblebees, indicating an earlier evolution in the bee lineage. Xenobiotic detoxification and immune genes are similarly depauperate in bumblebees and honeybees, and multiple categories of genes linked to social organization, including development and behavior, show high conservation. Key differences identified include a bias in bumblebee chemoreception towards gustation from olfaction, and striking differences in microRNAs, potentially responsible for gene regulation underlying social and other traits. Conclusions: These two bumblebee genomes provide a foundation for post-genomic research on these key pollinators and insect societies. Overall, gene repertoires suggest that the route to advanced eusociality in bees was mediated by many small changes in many genes and processes, and not by notable expansion or depauperation

Abstracts from the NIHR INVOLVE Conference 2017

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Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Scoping potential routes to UK civil unrest via the food system: Results of a structured expert elicitation

We report the results of a structured expert elicitation to identify the most likely typesof potential food system disruption scenarios for the UK, focusing on routes to civil unrest. Wetake a backcasting approach by defining as an end-point a societal event in which 1 in 2000 peoplehave been injured in the UK, which 40% of experts rated as “Possible (20–50%)”, “More likely thannot (50–80%)” or “Very likely (>80%)” over the coming decade. Over a timeframe of 50 years, thisincreased to 80% of experts. The experts considered two food system scenarios and ranked theirplausibility of contributing to the given societal scenario. For a timescale of 10 years, the majorityidentified a food distribution problem as the most likely. Over a timescale of 50 years, the expertswere more evenly split between the two scenarios, but over half thought the most likely route tocivil unrest would be a lack of total food in the UK. However, the experts stressed that the variouscauses of food system disruption are interconnected and can create cascading risks, highlighting theimportance of a systems approach. We encourage food system stakeholders to use these results intheir risk planning and recommend future work to support prevention, preparedness, response andrecovery planning