Improving the Health Care of Foster Children Throughout the US: Texas, a Case Example

Children who have been exposed to the foster care system comprise a high-risk, vulnerable, and potentially medically complex population that has both poor health and poor access to health care. This review with Texas as a case example aims to describe the health and health care issues impacting children in foster care (CFCs), the state and federal level mechanisms to ensure appropriate funding for the health care of CFCs, and recent legislative efforts to improve the health and health care access for CFCs. The review discusses potential solutions in regards to improving the health of CFCs through four main domains: facilitating integration of care through delivery mechanisms such as the medical home; understanding the role of trauma and toxic stress and consequently the impact of trauma-informed care on the health of CFCs; improving mental health screening efforts and tools; and enhancing access to appropriate mental health care services

Observations from the Balcony: Directions for Pediatric Health Disparities Research and Policy

In 2002, the Institute of Medicine released Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, a landmark monograph documenting health disparities in the U.S. health care system. Since the publication of Unequal Treatment, the field of pediatric health disparities research has advanced significantly with a proliferation of studies examining a wide array of topics concerning inequities in child health. Advances in health care policy and legislation have also added to a heightened discourse on pediatric health disparities. While there has been substantial activity in efforts to address pediatric health disparities, questions remain regarding whether these efforts have changed the trajectory of health equity among children. The aim of this paper is to examine the practical challenges of addressing pediatric health disparities in the dynamic context of global changes in health care research, policy, and legislation relevant to children. Using the Adaptive Leadership framework, this paper outlines a conceptual model for assessing the scope of progress made in addressing pediatric health disparities, diagnoses the continued adaptive challenges of pediatric health disparities, and provides an agenda for further work and future investment

Keys to academic success for under-represented minority young investigators: recommendations from the Research in Academic Pediatrics Initiative on Diversity (RAPID) National Advisory Committee.

BackgroundAlthough Latinos, African-Americans, and American Indians/Alaska Natives comprise 34% of Americans, these under-represented minorities (URMs) account for only 7% of US medical-school faculty. Even when URMs become faculty, they face many substantial challenges to success. Little has been published, however, on keys to academic success for URM young faculty investigators.MethodsThe Research in Academic Pediatrics Initiative on Diversity (RAPID) goal is to enhance the professional advancement of URM junior faculty pursuing research careers in general academic pediatrics. One important RAPID component is the annual mentoring/career-development conference, which targets URM residents, fellows, and junior faculty, and has included 62 URM participants since its 2013 inception. A conference highlight is the panel discussion on keys to academic success for URM young investigators, conducted by the RAPID National Advisory Committee, a diverse group of leading senior researchers. The article aim was to provide a guide to academic success for URM young investigators using the 2018 RAPID Conference panel discussion. A modified Delphi technique was used to provide a systematic approach to obtaining answers to six key questions using an expert panel: the single most important key to success for URM young investigators; ensuring optimal mentorship; how to respond when patients/families say, "I don't want you to see my child because you are ____"; best strategies for maximizing funding success; how to balance serving on time-consuming committees with enough time to advance research/career objectives; and the single thing you wish someone had told you which would have substantially enhanced your success early on.Results/conclusionsThis is the first published practical guide on keys to academic success for URM young investigators. Identified keys to success included having multiple mentors, writing prolifically, being tenaciously persistent, having mentors who are invested in you, dealing with families who do not want you to care for their child because of your race/ethnicity by seeking to understand the reasons and debriefing with colleagues, seeking non-traditional funding streams, balancing committee work with having enough time to advance one's research and career by using these opportunities to generate scholarly products, and asking for all needed resources when negotiating for new jobs

Hydroxyurea use among children with sickle cell anemia

This study describes hydroxyurea use among children ages 1 to 17 with sickle cell anemia (SCA) enrolled in at least one year of Medicaid in six states from 2005 to 2012. Administrative claims were used to summarize the number of days’ supply of hydroxyurea dispensed by state and year. A total of 7963 children with SCA contributed 22 424 person‐years. Among person‐years with greater than 30 days of hydroxyurea, only 18% received at least 300 days of hydroxyurea, which varied by state. Following updated recommendations for all children with SCA to be offered hydroxyurea, strategies to increase hydroxyurea adherence among this population are needed.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149259/1/pbc27721_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149259/2/pbc27721.pd

Trends in Child Health Insurance Coverage: A Local Perspective

Background: Over the past decade, the percentage of Americans with access to employer-sponsored insurance (ESI) has declined. Dependents, specifically children, are the most likely to bear the burden of lost coverage. Objectives: The objectives of this study were to 1) describe trends in children’s health insurance taking into account the heterogeneity across different sub-populations and 2) assess the associations between individual, local (offers of ESI), and supply side (proximity to safety net hospitals) characteristics and children’s health insurance. Methods: We analyzed locally collected survey data for children living in the 12 counties of greater Houston, Texas (years 2003, 2006, 2008, 2011). For each year, telephone interviews were conducted with caregivers through random digit dialing. Among households with at least one employed caregiver (N=2,508), we performed an adjusted multinomial logistic regression analysis to evaluate the odds of being publicly insured or uninsured, with the option for ESI and proximity to a public hospital as primary independent variables. Results: Low-income and racial/ethnic minority children experienced the largest increases in coverage through public insurance. Children in households without the option for ESI had higher odds (Odds ratio 10.87, 95% confidence interval 7.31-16.17) of being publicly insured or uninsured (Odds ratio 9.50, 95% confidence interval 6.14-14.70) compared to those in households with the option for ESI. Proximity to a public hospital was not associated with being uninsured. Conclusions: As the availability of ESI has declined, public insurance has acted as a safety net for low-income and minority children. While access to free care plays an important role, it may not substitute for insurance coverage

Dynamics of Ku and bacterial non-homologous end-joining characterized using single DNA molecule analysis

We use single-molecule techniques to characterize the dynamics of prokaryotic DNA repair by non-homologous end-joining (NHEJ), a system comprised only of the dimeric Ku and Ligase D (LigD). The Ku homodimer alone forms a ∼2 s synapsis between blunt DNA ends that is increased to ∼18 s upon addition of LigD, in a manner dependent on the C-terminal arms of Ku. The synapsis lifetime increases drastically for 4 nt complementary DNA overhangs, independently of the C-terminal arms of Ku. These observations are in contrast to human Ku, which is unable to bridge either of the two DNA substrates. We also demonstrate that bacterial Ku binds the DNA ends in a cooperative manner for synapsis initiation and remains stably bound at DNA junctions for several hours after ligation is completed, indicating that a system for removal of the proteins is active in vivo. Together these experiments shed light on the dynamics of bacterial NHEJ in DNA end recognition and processing. We speculate on the evolutionary similarities between bacterial and eukaryotic NHEJ and discuss how an increased understanding of bacterial NHEJ can open the door for future antibiotic therapies targeting this mechanism

SPICES: Spectro-Polarimetric Imaging and Characterization of Exoplanetary Systems

SPICES (Spectro-Polarimetric Imaging and Characterization of Exoplanetary Systems) is a five-year M-class mission proposed to ESA Cosmic Vision. Its purpose is to image and characterize long-period extrasolar planets and circumstellar disks in the visible (450 - 900 nm) at a spectral resolution of about 40 using both spectroscopy and polarimetry. By 2020/22, present and near-term instruments will have found several tens of planets that SPICES will be able to observe and study in detail. Equipped with a 1.5 m telescope, SPICES can preferentially access exoplanets located at several AUs (0.5-10 AU) from nearby stars ($<$25 pc) with masses ranging from a few Jupiter masses to Super Earths ($\sim$2 Earth radii, $\sim$10 M$_{\oplus}$) as well as circumstellar disks as faint as a few times the zodiacal light in the Solar System

Adapting Medical Guidelines to Be Patient-centered Using a Patient-driven Process for Individuals With Sickle Cell Disease and Their Caregivers

Background: Evidence-based guidelines for sickle cell disease (SCD) health maintenance and management have been developed for primary health care providers, but not for individuals with SCD. To improve the quality of care delivered to individuals with SCD and their caregivers, the main purposes of this study were to: (1) understand the desire for patient-centered guidelines among the SCD community; and (2) adapt guideline material to be patient-centered using community-engagement strategies involving health care providers, community -based organizations, and individuals with the disease. Methods: From May–December 2016, a volunteer sample of 107 individuals with SCD and their caregivers gave feedback at community forums (n = 64) and community listening sessions (n = 43) about technology use for health information and desire for SCD-related guidelines. A team of community research partners consisting of community stakeholders, individuals living with SCD, and providers and researchers (experts) in SCD at nine institutions adapted guidelines to be patient-centered based on the following criteria: (1) understandable, (2) actionable, and (3) useful. Results: In community forums (n = 64), almost all participants (91%) wanted direct access to the content of the guidelines. Participants wanted guidelines in more than one format including paper (73%) and mobile devices (79%). Guidelines were adapted to be patient-centered. After multiple iterations of feedback, 100% of participants said the guidelines were understandable, most (88%) said they were actionable, and everyone (100%) would use these adapted guidelines to discuss their medical care with their health care providers. Conclusions: Individuals with SCD and their caregivers want access to guidelines through multiple channels, including technology. Guidelines written for health care providers can be adapted to be patient-centered using Community-engaged research involving providers and patients. These patient-centered guidelines provide a framework for patients to discuss their medical care with their health care providers

In vitro Antiplasmodial Activities of Alkaloids Isolated from Roots of Worsleya procera (Lem.) Traub (Amaryllidaceae)

A combined phytochemical, crystallographic and biological study of Worsleya procera roots was performed. Fifteen alkaloids were identified by gas chromatography mass spectrometry (GC-MS) and seven of them were isolated. The structures of the alkaloids were elucidated by spectroscopic methods, and a detailed crystallographic study of tazettine was carried out. The isolated alkaloids and the obtained extracts were tested in vitro against Plasmodium falciparum (3D7 and K1 strains) and human hepatocarcinoma cells (HepG2) to assess their antiplasmodial and cytotoxic effects, respectively. One of the isolated alkaloid derivatives, lycorine, exhibited antiplasmodial activity against both sensitive (3D7) and resistant (K1) parasite strains in the low micromolar range (half-maximal sample inhibitory concentration (IC50) values of 2.5 and 3.1 µM, respectively) and displayed a low cytotoxicity profile, with a selectivity index greater than 100. Our findings indicate that lycorine is a hit for antimalarial drug discovery. Keywords: isoquinolinic alkaloids; Amaryllidaceae; Plasmodium falciparum; lycorine; tazettin