Key Findings From HSC's 2010 Site Visits: Health Care Markets Weather Economic Downturn, Brace for Health Reform

Presents findings about hospital payment rate increases, hospital-physician alignment, and insurance premiums, funding for safety-net providers, and their implications from HSC's site visits to twelve nationally representative metropolitan communities

Spatial analysis of colorectal cancer incidence and proportion of late-stage in Massachusetts residents: 1995–1998

<p>Abstract</p> <p>Background</p> <p>The aims of this study were to determine if observed geographic variations in colorectal cancer incidence are simply random or are statistically significant deviations from randomness, whether statistically significant excesses are temporary or persistent, and whether they can be explained by risk factors such as socioeconomic status (SES) or the percent of the population residing in an urban area rather than a rural area. Between 1995 and 1998, 6360 male and 6628 female invasive colorectal cancer cases were diagnosed in Massachusetts residents. Cases were aggregated to Census tracts and analyzed for deviations from random occurrence with respect to both location and time.</p> <p>Results</p> <p>Six geographic areas that deviated significantly from randomness were uncovered in the age-adjusted analyses of males: three with higher incidence rates than expected and eight lower than expected. In the age-adjusted analyses of females, one area with a higher incidence rate, and one area with a lower incidence rate than expected, were found. After adjustment for SES and percent urban, some of these areas were no longer significantly different.</p> <p>Conclusion</p> <p>Public health practitioners can use the results of this study to focus their attention onto areas in Massachusetts that need to increase colorectal screening or have elevated risk of colorectal cancer incidence.</p

The geographic distribution of melanoma incidence in Massachusetts, adjusted for covariates

BACKGROUND: The aims of this study were to determine whether observed geographic variations in melanoma cancer incidence in both gender groups are simply random or are statistically significant, whether statistically significant excesses are temporary or persistent, and whether they can be explained by risk factors such as socioeconomic status (SES) or the percent of the population residing in an urban rather than a rural area. Between 1990 and 1999, 4774 female and 5688 male melanomas were diagnosed in Massachusetts residents. Cases were aggregated to census tracts and analyzed for deviations from random occurrence with respect to both spatial location and time. RESULTS: Thirteen geographic areas that deviated significantly from randomness were uncovered in the age-adjusted analyses of males: five with higher incidence rates than expected and eight lower than expected. In the age-adjusted analyses of females, six areas with higher incidence rates and eight areas with lower than expected incidence rates were found. After adjustment for SES and percent urban, several of these areas were no longer significantly different. CONCLUSION: These analyses identify geographic areas with invasive melanoma incidence higher or lower than expected, the times of their excess, and whether or not their status is affected when the model is adjusted for risk factors. These surveillance findings can be a sound starting point for the shoe-leather epidemiologist

A Space-Time Analysis of the Proportion of Late Stage Breast Cancer in Massachusetts, 1988 to 1997.

BACKGROUND: Early detection is the best way to control breast cancer. This observational epidemiologic study uses ten years of data, 1988-1997, to determine whether the observed variations in the proportion of breast cancers diagnosed at late stage are simply random or are statistically significant with respect to both geographical location and time. RESULTS: A total of three spatial-temporal areas were found to deviate significantly from randomness in the unadjusted analysis; one of the three areas contained statistically significant excesses in proportion of late stage, while two areas were identified as significantly lower than expected. The area of excess spanned the first three years of the study period, while the low areas spanned the last five years of the study period. Some of these areas were no longer statistically significant when adjustments were made for SES and urban/rural status. CONCLUSION: Although there was an area of excess in eastern Massachusetts, it only spanned the first three years of the study period. The low areas were fairly consistent, spanning the last five years of the study period

Coming to America: Multiple Origins of New World Geckos

Geckos in the Western Hemisphere provide an excellent model to study faunal assembly at a continental scale. We generated a time-calibrated phylogeny, including exemplars of all New World gecko genera, to produce a biogeographic scenario for the New World geckos. Patterns of New World gecko origins are consistent with almost every biogeographic scenario utilized by a terrestrial vertebrate with different New World lineages showing evidence of vicariance, dispersal via temporary land bridge, overseas dispersal, or anthropogenic introductions. We also recovered a strong relationship between clade age and species diversity, with older New World lineages having more species than more recently arrived lineages. Our data provide the first phylogenetic hypothesis for all New World geckos and highlight the intricate origins and ongoing organization of continental faunas. The phylogenetic and biogeographical hypotheses presented here provide an historical framework to further pursue research on the diversification and assembly of the New World herpetofauna

Polyadenylation regulates the stability of Trypanosoma brucei mitochondrial RNAs

Polyadenylation of RNAs plays a critical role in modulating rates of RNA turnover and ultimately in controlling gene expression in all systems examined to date. In mitochondria, the precise mechanisms by which RNAs are degraded, including the role of polyadenylation, are not well understood. Our previous in organello pulse-chase experiments suggest that poly(A) tails stimulate degradation of mRNAs in the mitochondria of the protozoan parasite Trypanosoma brucei (Militello, K. T., and Read, L. K. (2000) Mol. Cell. Biol. 21, 731-742). In this report, we developed an in vitro assay to directly examine the effects of specific 3′-sequences on RNA degradation. We found that a salt-extracted mitochondrial membrane fraction preferentially degraded polyadenylated mitochondrially and non-mitochondrially encoded RNAs over their non-adenylated counterparts. A poly(A) tail as short as 5 nucleotides was sufficient to stimulate rapid degradation, although an in vivo tail length of 20 adenosines supported the most rapid decay. A poly(U) extension did not promote rapid RNA degradation, and RNA turnover was slowed by the addition of uridine residues to the poly(A) tail. To stimulate degradation, the poly(A) element must be located at the 3′ terminus of the RNA. Finally, we demonstrate that degradation of polyadenylated RNAs occurs in the 3′ to 5′ direction through the action of a hydrolytic exonuclease. These experiments demonstrate that the poly(A) tail can act as a cis-acting element to facilitate degradation of T. brucei mitochondrial mRNAs

A pilot randomised controlled trial to reduce suffering and emotional distress in patients with advanced cancer

Introduction: A pilot trial was carried out to determine if a focussed narrative interview could alleviate the components of suffering and anxiety and depression in advanced cancer patients. InterventionPatients recruited were invited to participate in a focussed narrative interview and reflect on their perspectives on their sense of &ldquo;meaning&rdquo;, regarding suffering and their psychological, physical, social and spiritual well being &ndash; the emphasis was on allowing the patient to tell their story. Patients were encouraged to share what resources they themselves had utilised in addition to what professional care they may have received, to maintain a sense of well being. Method: Patients with advanced metastatic disease were recruited from hospices in the North West of England &ndash; the only exclusion criteria were not being able to understand written and spoken English and a non cancer diagnosis. At recruitment patients were asked to complete a numerical scale for suffering; the Brief Edinburgh Depression Scale, Edmonton Symptom Assessment Scale (ESAS), FACIT Spiritual well being questionnaire, Demographic information was collected and patients were randomised to either the intervention arm of the trial or the usual care arm of the study. Patients in both groups were invited to complete each measure at 2, 4 and 8 weeks. Results: One hundred people were recruited into the study &ndash; 49 were randomised to intervention group and 51 to control group. The median age of patients was 66 years age range (31&ndash;89 years) and 68% of patients were female. At baseline the ECOG performance of 75% of patients recruited was 1 or 2. The median survival of all patients in the study was 169.5 days (range 10 days to still alive at end of study). There was no significant difference at any timepoint in scores on suffering measure between intervention group and control group. At each time point the intervention demonstrated mean improvement in scores for depression and anxiety on ESAS &ndash; the greatest changes for both depression and anxiety were seen at 4 weeks. Conclusion: This pilot randomised controlled trial of a focussed narrative intervention demonstrated an improvement in mean changes in scores for depression and anxiety at 2, 4, and 8 weeks. We suggest this intervention may have beneficial effects on depression and anxiety, but a larger powered trial is required to determine the full effects

A study of glycaemic effects following acute anthocyanin-rich blueberry supplementation in healthy young adults

The postprandial response to ingested carbohydrate is recognised as a marker of metabolic health. Postprandial hyperglycaemia is observed in type 2 diabetes mellitus and is a significant risk factor for cardiovascular disease. Cognitive deficits are also associated with type 2 diabetes. Therefore interventions which moderate postprandial glucose profiles are desirable. Here we investigated the impact of anthocyanin-rich wild blueberries on postprandial glucose response. Seventeen healthy young adults consumed a range of doses of freeze-dried wild blueberry powder, in smoothie form, in both sugar-matched and no-added-sugar conditions. Plasma glucose was determined by a capillary sampling method at baseline and at regular intervals up to 2.5 hours postprandially. Blueberries were observed to significantly extend the postprandial glucose response beyond the period observed for a sugar-matched control, characteristic of a beneficial glycaemic response. Furthermore, blueberries were observed to reduce peak postprandial glucose levels, although statistical significance was not achieved. The findings suggest a tempering of the postprandial glucose response in the presence of anthocyanin-rich blueberry, and are discussed with reference to likely glucoregulatory mechanisms of action and their implications for cognitive and type 2 diabetes research