What Would Health Care Reform Mean for Small Employers and Their Workers?

Analyzes the implications of the House and Senate reform bills for improving access to and affordability of insurance for small employers. Examines the proposed insurance exchanges, market reforms, subsidies for low-income individuals, and tax provisions

The Effects of Health Reform on Small Businesses and Their Workers

Synthesizes research findings about how the 2010 healthcare reform will affect small business owners and employees, including savings in healthcare costs and premium contributions, coverage for workers and dependents, offer rates, and number of uninsured

Mapping of bioavailable strontium isotope ratios in France for archaeological provenance studies

Strontium isotope ratios (⁸⁷Sr/⁸⁶Sr) of archaeological samples (teeth and bones) can be used to track mobility and migration across geologically distinct landscapes. However, traditional interpolation algorithms and classification approaches used to generate Sr isoscapes are often limited in predicting multiscale ⁸⁷Sr/⁸⁶Sr patterning. Here we investigate the suitability of plant samples and soil leachates from the IRHUM database (www.irhumdatabase.com) to create a bioavailable ⁸⁷Sr/⁸⁶Sr map using a novel geostatistical framework. First, we generated an ⁸⁷Sr/⁸⁶Sr map by classifying ⁸⁷Sr/⁸⁶Sr values into five geologically-representative isotope groups using cluster analysis. The isotope groups were then used as a covariate in kriging to integrate prior geological knowledge of Sr cycling with the information contained in the bioavailable dataset and enhance ⁸⁷Sr/⁸⁶Sr predictions. Our approach couples the strengths of classification and geostatistical methods to generate more accurate ⁸⁷Sr/⁸⁶Sr predictions (Root Mean Squared Error = 0.0029) with an estimate of spatial uncertainty based on lithology and sample density. This bioavailable Sr isoscape is applicable for provenance studies in France, and the method is transferable to other areas with high sampling density. While our method is a step forward in generating accurate ⁸⁷Sr/⁸⁶Sr isoscapes, the remaining uncertainty also demonstrates that fine-modelling of ⁸⁷Sr/⁸⁶Sr variability is challenging and requires more than geological maps for accurately predicting ⁸⁷Sr/⁸⁶Sr variations across the landscape. Future efforts should focus on increasing sampling density and developing predictive models to further quantify and predict the processes that lead to ⁸⁷Sr/⁸⁶Sr variability.Funding was provided by ARC DP110101415 (Grün, Spriggs, Armstrong, Maureille and Falguères) Understanding the migrations of prehistoric populations through direct dating and isotopic tracking of their mobility patterns. Part of this research was supported by the Australian French Association for Science & Technology through the ACT Science Fellowship program (2013) to M. Willme

Investigating Whether Consuming Meals in a Dining Room Impacts Patients’ Mood, Level of Interaction, and Subsequent Nutrient Intake in a Stroke Rehabilitation Ward.

Background/objectivesMalnutrition is evident in hospitals and stroke patients are at increased risk. Protected mealtimes may help increase nutrient intake especially when patients interact and enjoy the dining room atmosphere. The aim of this research is to investigate if eating in a communal dining room increases nutritional intake compared to eating at the bedside and to investigate whether patient interaction and mood affects patient nutrient intake. Population/methods:A randomised cross-sectional study of 20 patients, assessing a comparison of patient’s mealtime consumption at lunchtime in the dining room and at the beside. Patients’ meals were weighed before and after consumption as well as an estimated percentage of their meals consumed. Patients’ interaction was observed and noted using a modified case report form. The Hammond depression scale was used to score patients’ mood. Patient and staff satisfaction surveys were completed at the end of the study period. Results:There was no significant difference in protein and energy consumption in the dining room (16.4g protein and 379.2kcal) compared to at the bedside (13.2g protein and 333.8kcal), p=0.160 and p=0.110 respectively. Interaction was higher in the dining room. The percentage mealtime consumption increased the more interactive a patient was from a mean of 74% in less interactive patients to 98% in highly interactive patients (p=0.193). There was no significant association between depression score and mealtime consumption. All 19 patients enjoyed eating in the dining room and 14 out of the 19 patients preferred eating in the dining room. Conclusion:Further studies are required to explore how intake can be improved among stroke rehabilitation patients

Bioavailable soil and rock strontium isotope data from Israel

Strontium isotope ratios (87Sr / 86Sr) of biogenic material such as bones and teeth reflect the local sources of strontium ingested as food and drink during their formation. This has led to the use of strontium isotope ratios as a geochemical tracer in a wide range of fields including archaeology, ecology, food studies and forensic sciences. In order to utilise strontium as a geochemical tracer, baseline data of bioavailable 87Sr / 86Sr in the region of interest are required, and a growing number of studies have developed reference maps for this purpose in various geographic regions, and over varying scales. This study presents a new data set of bioavailable strontium isotope ratios from rock and soil samples across Israel, as well as from sediment layers from seven key archaeological sites. This data set may be viewed and accessed both in an Open Science Framework repository (https://doi.org/10.17605/OSF.IO/XKJ5Y, Moffat et al., 2020) or via the IRHUM (Isotopic Reconstruction of Human Migration) database.This research has been supported by the Australian Research Council (grant nos. DP0664144, DP110101417, and DE160100703) and the Flinders University (Research Investment Fund Grant)

Dichloroacetate prevents cisplatin-induced nephrotoxicity without compromising cisplatin anticancer properties

Cisplatin is an effective anticancer drug; however, cisplatin use often leads to nephrotoxicity, which limits its clinical effectiveness. In this study, we determined the effect of dichloroacetate, a novel anticancer agent, in a mouse model of cisplatin-induced AKI. Pretreatment with dichloroacetate significantly attenuated the cisplatin-induced increase in BUN and serum creatinine levels, renal tubular apoptosis, and oxidative stress. Additionally, pretreatment with dichloroacetate accelerated tubular regeneration after cisplatin-induced renal damage. Whole transcriptome sequencing revealed that dichloroacetate prevented mitochondrial dysfunction and preserved the energy-generating capacity of the kidneys by preventing the cisplatin-induced downregulation of fatty acid and glucose oxidation, and of genes involved in the Krebs cycle and oxidative phosphorylation. Notably, dichloroacetate did not interfere with the anticancer activity of cisplatin in vivo. These data provide strong evidence that dichloroacetate preserves renal function when used in conjunction with cisplatin

Mapping of bioavailable strontium isotope ratios in France for archaeological provenance studies

© 2017 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (Dec 2017) in accordance with the publisher’s archiving policyStrontium isotope ratios (87Sr/86Sr) of archaeological samples (teeth and bones) can be used to track mobility and migration across geologically distinct landscapes. However, traditional interpolation algorithms and classification approaches used to generate Sr isoscapes are often limited in predicting multiscale 87Sr/86Sr patterning. Here we investigate the suitability of plant samples and soil leachates from the IRHUM database (www.irhumdatabase.com) to create a bioavailable 87Sr/86Sr map using a novel geostatistical framework. First, we generated an 87Sr/86Sr map by classifying 87Sr/86Sr values into five geologically-representative isotope groups using cluster analysis. The isotope groups were then used as a covariate in kriging to integrate prior geological knowledge of Sr cycling with the information contained in the bioavailable dataset and enhance 87Sr/86Sr predictions. Our approach couples the strengths of classification and geostatistical methods to generate more accurate 87Sr/86Sr predictions (Root Mean Squared Error = 0.0029) with an estimate of spatial uncertainty based on lithology and sample density. This bioavailable Sr isoscape is applicable for provenance studies in France, and the method is transferable to other areas with high sampling density. While our method is a step forward in generating accurate 87Sr/86Sr isoscapes, the remaining uncertainty also demonstrates that fine-modelling of 87Sr/86Sr variability is challenging and requires more than geological maps for accurately predicting 87Sr/86Sr variations across the landscape. Future efforts should focus on increasing sampling density and developing predictive models to further quantify and predict the processes that lead to 87Sr/86Sr variability

Can pneumococcal meningitis surveillance be used to assess the impact of pneumococcal conjugate vaccine on total invasive pneumococcal disease? A case-study from South Africa, 2005–2016

INTRODUCTION : South Africa introduced seven-valent pneumococcal conjugate vaccine (PCV7) in 2009 and PCV13 in 2011. We aimed to compare the estimated impact of PCV on pneumococcal meningitis (PM) to impact of PCV on total invasive pneumococcal disease (tIPD) based on risk reduction after PCV introduction. METHODS : We conducted national, laboratory-based surveillance for tIPD during 2005–2016. We estimated and compared rates of PCV13 and non-PCV13 serotype disease among tIPD and PM in individuals aged <5 years and ≥5 years, and compared these rates between the 2005–2008 pre-PCV introduction period and two time points after PCV introduction, 2012 and 2016. RESULTS : We enrolled 45,853 tIPD cases; 17,251 (38%) were PM. By 2016, IPD caused by all serotypes decreased 55% (95%CI −57% to −53%) for tIPD, and 54% for PM (95%CI −58% to −51%), 0.7% difference between estimates (p = 0.7). No significant differences were observed between PCV7-serotype disease reduction in tIPD and PM in both age groups or the additional 6 serotypes included in PCV13 in <5 year olds in 2012 and 2016. In 2012 there was a significant difference between increases in non-PCV13 serotype disease in those ≥5 years for tIPD and PM (32% greater increase in PM, p < 0.001), but this difference was absent by 2016. There was a significant difference between the estimated decrease in additional PCV13 type disease in 2016 between tIPD and PM for those aged ≥5 years (28% greater reduction in PM, p = 0.008). CONCLUSION : PM showed similar reductions to tIPD seven years after PCV introduction in vaccine serotype disease in those <5 years, and increases in non-vaccine serotype disease in all ages.The National Institute for Communicable Diseases a division of the National Health Laboratory Service, South Africa; the United States Agency for International Development’s Antimicrobial Resistance Initiative, United States of America, transferred via a cooperative agreement [U60/CCU022088] from the United States Centers for Disease Control and Prevention, United States if Ameriva; and the United States Centers for Disease Control and Prevention [U62/CCU022901], United States of America.http://www.elsevier.com/locate/vaccine2020-09-10hj2019School of Health Systems and Public Health (SHSPH

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p&lt;0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p&lt;0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p&lt;0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP &gt;5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570