Identification and Assessment of Children and Youth with Special Health Care Needs in Medicaid Managed Care: Approaches from Three States

Increasingly, states are relying on managed care delivery systems to serve Medicaid enrollees that have historically been exempt from enrollment in managed care, such as children and youth with special health care needs (CYSHCN). The federal Medicaid managed care regulations establish the broad requirements for states to identify and assess individuals with special health care needs. However, little has been recently documented about specific state policies or procedures for identifying and assessing CYSHCN. This reportlooks at such approaches in three states -- California, Massachusetts and Michigan -- and includes some promising practices states may consider in implementing Medicaid managed care for this vulnerable population

P-12 The Potential of Omega-3 Fatty Acids in Treating Bipolar Disorder through the Metabolic Pathway of Inositol

Bipolar disorder is a mental disorder characterized by extreme mood swings. Omega-3-fatty acids have been shown to relieve symptoms of bipolar disorder and are not associated with the negative side effects of lithium and valproate, the two most common treatments of the disorder. However, omega-3-fatty acids’ mechanism of action remains unknown. This study examined the effects of omega-3 fatty acid docosahexaenoic acid (DHA) on intracellular inositol levels of Saccharomyces Cerevisiae. We show that similar to valproate, DHA decreases the growth of Saccharomyces Cerevisiae. We also show that unlike valproate, DHA does not decrease intracellular inositol levels

The Effects of Omega-3 Fatty Acids on Intracellular Inositol Levels in Saccharomyces Cerevisiae

Bipolar disorder is a severe and chronic debilitating mental disorder characterized by extreme mood swings between mania and depression. The current medications for bipolar disorder, lithium and valproate, have been associated with numerous negative side effects. Although the therapeutic mechanism by which lithium and valproate (VPA) exert their effect is unknown, a leading hypothesis implicates inositol depletion as a mechanism of action. On the other hand, omega-3-fatty acids have been shown to relieve symptoms of bipolar disorder. In this study, we compare the effects of VPA to the effects of decosahexaenoic acid (DHA) on Saccharomyces cerevisiae growth and intracellular inositol concentration. Intracellular inositol levels were examined using a modified enzymatic assay for inositol, which correlates light absorbance to intracellular inositol concentration. The results show that similar to valproate, DHA inhibits cell growth. In addition, unlike valproate, DHA does not decrease intracellular inositol levels

Early childhood parent-reported speech problems in small and large for gestational age term-born and preterm-born infants: a cohort study

Objective (1) To assess if preterm and term small for gestational age (SGA) or large for gestational age (LGA) infants have more parent-reported speech problems in early childhood compared with infants with birth weights appropriate for gestational age (AGA). (2) To assess if preterm and term SGA and LGA infants have more parent-reported learning, behavioural, hearing, movement and hand problems in early childhood compared with AGA infants. Design Cohort study. Setting Wales, UK. Participants 7004 children with neurodevelopmental outcomes from the Respiratory and Neurological Outcomes of Children Born Preterm Study which enrolled 7129 children, born from 23 weeks of gestation onwards, to mothers aged 18–50 years of age were included in the analysis. Outcome measures Parent-reported single-answer questionnaires were completed in 2013 to assess early childhood neurodevelopmental outcomes. The primary outcome was parent-reported speech problems in early childhood adjusted for clinical and demographic confounders in SGA and LGA infants compared with AGA infants. Secondary outcomes measured were parent-reported early childhood learning, behavioural, hearing, movement and hand problems. Results Median age at the time of study was 5 years, range 2–10 years. Although the adjusted OR was 1.19 (0.92 to 1.55) for SGA infants and OR 1.11 (0.88 to 1.41) for LGA infants, this failed to reach statistical significance that these subgroups were more likely to have parent-reported speech problems in early childhood compared with AGA infants. This study also found parent-reported evidence suggestive of potential learning difficulties in early childhood (OR 1.51 (1.13 to 2.02)) and behavioural problems (OR 1.35 (1.01 to 1.79)) in SGA infants. Conclusion This study of 7004 infants in Wales suggests that infants born SGA or LGA likely do not have higher risks of parent-reported speech problems in early childhood compared with infants born AGA. To further ascertain this finding, studies with wider population coverage and longer-term follow-up would be needed

Factors Associated with Access to Immunotherapy and Its Impact on Survival in Mucosal Melanoma

Mucosal melanoma is rare, comprising only 1.4% of all melanomas in the United States. Yet it is associated with a worse prognosis compared to cutaneous melanoma due to aggressive biology and advanced stage at diagnosis with a reported 5-year survival rate of less than 30%. Although there are no established guidelines for the treatment of mucosal melanoma, immunotherapy has been increasingly used for the management of advanced mucosal melanoma

Serum neurofilament dynamics predicts neurodegeneration and clinical progression in presymptomatic Alzheimer's disease

Neurofilament light chain (NfL) is a promising fluid biomarker of disease progression for various cerebral proteopathies. Here we leverage the unique characteristics of the Dominantly Inherited Alzheimer Network and ultrasensitive immunoassay technology to demonstrate that NfL levels in the cerebrospinal fluid (n = 187) and serum (n = 405) are correlated with one another and are elevated at the presymptomatic stages of familial Alzheimer's disease. Longitudinal, within-person analysis of serum NfL dynamics (n = 196) confirmed this elevation and further revealed that the rate of change of serum NfL could discriminate mutation carriers from non-mutation carriers almost a decade earlier than cross-sectional absolute NfL levels (that is, 16.2 versus 6.8 years before the estimated symptom onset). Serum NfL rate of change peaked in participants converting from the presymptomatic to the symptomatic stage and was associated with cortical thinning assessed by magnetic resonance imaging, but less so with amyloid-β deposition or glucose metabolism (assessed by positron emission tomography). Serum NfL was predictive for both the rate of cortical thinning and cognitive changes assessed by the Mini-Mental State Examination and Logical Memory test. Thus, NfL dynamics in serum predict disease progression and brain neurodegeneration at the early presymptomatic stages of familial Alzheimer's disease, which supports its potential utility as a clinically useful biomarker

LSST: from Science Drivers to Reference Design and Anticipated Data Products

(Abridged) We describe here the most ambitious survey currently planned in the optical, the Large Synoptic Survey Telescope (LSST). A vast array of science will be enabled by a single wide-deep-fast sky survey, and LSST will have unique survey capability in the faint time domain. The LSST design is driven by four main science themes: probing dark energy and dark matter, taking an inventory of the Solar System, exploring the transient optical sky, and mapping the Milky Way. LSST will be a wide-field ground-based system sited at Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m effective) primary mirror, a 9.6 deg$^2$ field of view, and a 3.2 Gigapixel camera. The standard observing sequence will consist of pairs of 15-second exposures in a given field, with two such visits in each pointing in a given night. With these repeats, the LSST system is capable of imaging about 10,000 square degrees of sky in a single filter in three nights. The typical 5$\sigma$ point-source depth in a single visit in $r$ will be $\sim 24.5$ (AB). The project is in the construction phase and will begin regular survey operations by 2022. The survey area will be contained within 30,000 deg$^2$ with $\delta<+34.5^\circ$, and will be imaged multiple times in six bands, $ugrizy$, covering the wavelength range 320--1050 nm. About 90\% of the observing time will be devoted to a deep-wide-fast survey mode which will uniformly observe a 18,000 deg$^2$ region about 800 times (summed over all six bands) during the anticipated 10 years of operations, and yield a coadded map to $r\sim27.5$. The remaining 10\% of the observing time will be allocated to projects such as a Very Deep and Fast time domain survey. The goal is to make LSST data products, including a relational database of about 32 trillion observations of 40 billion objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures available from https://www.lsst.org/overvie

Seroepidemiology of coxsackievirus A6, coxsackievirus A16, and Enterovirus 71 infections among children and adolescents in Singapore, 2008-2010

10.1371/journal.pone.0127999PLoS ONE105e012799