An Anticipatory Geriatric Strategy: To Better Care for Those Americans Not Yet Old

Current US public policy decisions will have impact on national plans to care for the aging American baby boomer population over the next several decades. The recent health care legislative debate has been largely about the structure of health care for those still too young to be covered by Medicare, but the legislation may have important implications for the average rates of accumulating chronic illness and disability in midlife and influence the care needs for that cohort of individuals even after they become elderly

An Anticipatory Geriatric Strategy: To Better Care for Those Americans Not Yet Old

Current US public policy decisions will have impact on national plans to care for the aging American baby boomer population over the next several decades. The recent health care legislative debate has been largely about the structure of health care for those still too young to be covered by Medicare, but the legislation may have important implications for the average rates of accumulating chronic illness and disability in midlife and influence the care needs for that cohort of individuals even after they become elderly. As we prepare for the aging of the American baby boomer population, much focus has come to the issue of the expected costs of providing that care, and this issue has figured prominently in the ongoing discussions about implementation of the recent national health care legislation. The future cost of caring for an aging population can be decomposed into three separate factors. The first of these factors, the numbers of middle-aged Americans poised to become elderly in the next several decades, is essentially an immutable quantity. The second factor, the cost of caring for each episode of illness, has received much attention during the health care debates of recent months, with a variety of strategies (such as use of electronic health records to guide care, measures to avoid duplicative laboratory tests, and increased resources to ferret out healthcare fraud) being proposed to make health care delivery more cost effective. The third factor of the equation, which has gotten much less attention, is the average level of baseline health of the older individual, which in turn drives the average amount of care that needs to be delivered to a given older individual per year. It may be particularly useful to focus on the subset of health care interventions that represents "dominating" strategies; that is, those interventions which produce an improvement in public health at the same time that they also save money. A focus on such dominating strategies can offer an initial opportunity to begin the process of expanding the health care safety net in a relatively painless fashion, to precede the much more challenging task of making costbenefit decisions about other health care efforts that do not save money but that are cost effective

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Comprehensive variation discovery in single human genomes

Complete knowledge of the genetic variation in individual human genomes is a crucial foundation for understanding the etiology of disease. Genetic variation is typically characterized by sequencing individual genomes and comparing reads to a reference. Existing methods do an excellent job of detecting variants in approximately 90% of the human genome, however calling variants in the remaining 10% of the genome (largely low-complexity sequence and segmental duplications) is challenging. To improve variant calling, we developed a new algorithm, DISCOVAR, and examined its performance on improved, low-cost sequence data. Using a newly created reference set of variants from finished sequence of 103 randomly chosen Fosmids, we find that some standard variant call sets miss up to 25% of variants. We show that the combination of new methods and improved data increases sensitivity several-fold, with the greatest impact in challenging regions of the human genome