Rural Elder Care Coordination on Cape Cod: A Community-Based Approach to Closing the Gaps

One quarter of the population of Cape Cod is over age 65, and in the eight outermost towns on the peninsula of Cape Cod, known as the Lower and Outer Cape, the challenges of caring for an older population are compounded by the effects of rural isolation. As many residents have chosen to “age in place” with little family or social support, medical and behavioral health needs often go unaddressed due to the lack of access to needed healthcare and supporting services that plagues underserved rural areas. Outer Cape Health Services (OCHS), a federally-qualified community health center and the primary medical and behavioral health provider in the area, has established a home visit program to reach isolated patients who may otherwise be denied access to these services. This program is lead by the Care Coordination team, which collaborates with local Councils on Aging, the Visiting Nurses Association, EMS, and other community resources to identify and engage these complex, high-acuity patients and provide wrap-around services. However, gaps remain in communication among agencies regarding existing and potential cases. Additionally, little data exist on the health challenges faced by this underserved population, and how care coordination can better address medical and psychosocial needs. To address these gaps, a cross-departmental team at OCHS has begun a community-based research project with the goal of developing a network of consumers, providers and agencies to develop research questions and collaborate on interventions. The team is in the process of identifying key stakeholders and developing community-building strategies

Pro-inflammatory profile of preeclamptic placental mesenchymal stromal cells: new insights into the etiopathogenesis of preeclampsia.

The objective of the present study was to evaluate whether placental mesenchymal stromal cells (PDMSCs) derived from normal and preeclamptic (PE) chorionic villous tissue presented differences in their cytokines expression profiles. Moreover, we investigated the effects of conditioned media from normal and PE-PDMSCs on the expression of pro-inflammatory Macrophage migration Inhibitory Factor (MIF), Vascular Endothelial Growth Factor (VEGF), soluble FMS-like tyrosine kinase-1 (sFlt-1) and free β-human Chorionic Gonadotropin (βhCG) by normal term villous explants. This information will help to understand whether anomalies in PE-PDMSCs could cause or contribute to the anomalies typical of preeclampsia. METHODS: Chorionic villous PDMSCs were isolated from severe preeclamptic (n = 12) and physiological control term (n = 12) placentae. Control and PE-PDMSCs’s cytokines expression profiles were determined by Cytokine Array. Control and PE-PDMSCs were plated for 72 h and conditioned media (CM) was collected. Physiological villous explants (n = 48) were treated with control or PE-PDMSCs CM for 72 h and processed for mRNA and protein isolation. MIF, VEGF and sFlt-1 mRNA and protein expression were analyzed by Real Time PCR and Western Blot respectively. Free βhCG was assessed by immunofluorescent. RESULTS: Cytokine array showed increased release of pro-inflammatory cytokines by PE relative to control PDMSCs. Physiological explants treated with PE-PDMSCs CM showed significantly increased MIF and sFlt-1 expression relative to untreated and control PDMSCs CM explants. Interestingly, both control and PE-PDMSCs media induced VEGF mRNA increase while only normal PDMSCs media promoted VEGF protein accumulation. PE-PDMSCs CM explants released significantly increased amounts of free βhCG relative to normal PDMSCs CM ones. CONCLUSIONS: Herein, we reported elevated production of pro-inflammatory cytokines by PE-PDMSCs. Importantly, PE PDMSCs induced a PE-like phenotype in physiological villous explants. Our data clearly depict chorionic mesenchymal stromal cells as central players in placental physiopathology, thus opening to new intriguing perspectives for the treatment of human placental-related disorders as preeclampsia

Mesenchymal stromal cells for cardiovascular disease

The fields of regenerative medicine and cellular therapy have been the subject of tremendous hype and hope. In particular, the perceived usage of somatic cells like mesenchymal stromal cells (MSCs) has captured the imagination of many. MSCs are a rare population of cells found in multiple regions within the body that can be readily expanded ex vivo and utilized clinically. Originally, it was hypothesized that transplantation of MSCs to sites of injury would lead to de novo tissue-specific differentiation and thereby replace damaged tissue. Now, it is generally agreed that MSC home to sites of injury and direct positive remodeling via the secretion of paracrine factors. Consequently, their clinical utilization has largely revolved around their abilities to promote neovascularization for ischemic disorders and modulate overly exuberant inflammatory responses for autoimmune and alloimmune conditions. One of the major issues surrounding the development of somatic cell therapies like MSCs is that despite evoking a positive response, long-term engraftment and persistence of these cells is rare. Consequently, very large cell doses need be administered for raising production, delivery, and efficacy issues. In this review, we will outline the field of MSC in the context of ischemia and discuss causes for their lack of persistence. In addition, some of the methodologies be used to enhance their therapeutic potential will be highlighted

Mesenchymal stem cells: from experiment to clinic

There is currently much interest in adult mesenchymal stem cells (MSCs) and their ability to differentiate into other cell types, and to partake in the anatomy and physiology of remote organs. It is now clear these cells may be purified from several organs in the body besides bone marrow. MSCs take part in wound healing by contributing to myofibroblast and possibly fibroblast populations, and may be involved in epithelial tissue regeneration in certain organs, although this remains more controversial. In this review, we examine the ability of MSCs to modulate liver, kidney, heart and intestinal repair, and we update their opposing qualities of being less immunogenic and therefore tolerated in a transplant situation, yet being able to contribute to xenograft models of human tumour formation in other contexts. However, such observations have not been replicated in the clinic. Recent studies showing the clinical safety of MSC in several pathologies are discussed. The possible opposing powers of MSC need careful understanding and control if their clinical potential is to be realised with long-term safety for patients

"'The Moving Panorama—or Spring Garden Rout"

Anticipating the tweet, the speech bubbles advertise the Marshalls' moving panorama as the best of their kind. One man queries: "Do you think it is worth half a crown (a very large sum for an entertainment) to see it my Dear?" and his wife (presumably) responds, "Half a Crown! I assure you it's worth a Sovereign, it beats all the panoramas I ever saw." Because panorama exhibitions like these moved from urban center to urban center, it was crucial to generate buzz. Here, panorama viewing becomes a nascent form of cultural capital

‘Key to the Eidophusikon or Moving Diorama of Venice’

How does one enliven an engraved surface into a moving picture or simulation? In this fold-out plate, viewers are prepared to encounter "The Diorama," to enter a three-dimensional space complete with music, where a virtual tour of Venice is to be had all without ever having to leave industrial Glasgow

"Kenilworth"

Much like the Duke in Browning's "My Last Duchess" who unveils the portrait of his murdered wife, the owner of this fore-edge painting could unveil a hidden secret. The challenges of painting on a moving surface and of encompassing such a large scene on so small a space are not to be underestimated

"‘A Balloon Prospect from above the Clouds’. Publish’d May 1st. 1786, by T. Baldwin"

Ballooning made possible new prospects from which to view scenes: new means of encountering the infinite from a finite perspective, and fresh ways of considering the relation of the real to the unreal or even surreal. Looking down upon the clouds gave one a heady sense of visual command

‘The Balloon Over Helsbye Hill in Cheshire’

Writing in Airopaidia: Containing the Narrative of a Balloon Excursion (1786), Thomas Baldwin describes this view as "taken in a high Field, at the End of Sutton-Causeway," while looking to the southwest, 2.30PM "on Thursday the 8th of September, 1785" (iv). It comprises three horizontal panels, which offer in turn, beginning from the lower-margin of the design: first a beautiful, then a sublime and, finally, a hyper-sublime landscape

"'Port Dick, near Cook’s Inlet’, by Henry Humphrys"

In this scene, the Alutiiq Indians are dwarfed by the landscape and sky. Not only are they subjected to the surveillance/discovery of Captain Vancouver, but their smallness of scale, and the absence of any mention of human presence in the short title, perhaps hints at their merely temporary occupation of the scene. Several questions arise: does their exoticism enhance or undermine the sublime? Moreover, is this a Kantian sublime that highlights mind over nature or a Burkean one that insists upon the physiological experience of pain and pleasure