Designing Administrative Organizations for Health Reform

Describes proposals to create new entities to research comparative effectiveness, make coverage decisions, manage health insurance markets, or offer a public health insurance plan. Discusses types of agencies and considerations for organizational design

Administering Health Insurance Mandates

Provides an overview of health insurance mandates and administrative considerations. Based on a review of existing and proposed employer and individual mandates, outlines ways to structure them to be administered fairly and effectively

Governance Issues for Health Insurance Exchanges

Outlines considerations for states in deciding how to structure a health insurance exchange, as well as issues of funding sources, operational flexibility, political independence and accountability, management structure, and sub-state dimensions

Neonatal cytokines and chemokines and risk of Autism Spectrum Disorder: the Early Markers for Autism (EMA) study: a case-control study.

BackgroundBiologic markers of infection and inflammation have been associated with Autism Spectrum Disorders (ASD) but prior studies have largely relied on specimens taken after clinical diagnosis. Research on potential biologic markers early in neurodevelopment is required to evaluate possible causal pathways and screening profiles.ObjectiveTo investigate levels of cytokines and chemokines in newborn blood specimens as possible early biologic markers for autism.MethodsWe conducted a population-based case-control study nested within the cohort of infants born from July 2000 to September 2001 to women who participated in the prenatal screening program in Orange County, California, USA. The study population included children ascertained from the California Department of Developmental Services with Autism Spectrum Disorder (ASD, n = 84), or developmental delay but not ASD (DD, n = 49), and general population controls randomly sampled from the birth certificate files and frequency matched to ASD cases on sex, birth month and birth year (GP, n = 159). Cytokine and chemokine concentrations were measured in archived neonatal blood specimens collected for routine newborn screening.ResultsCytokines were not detected in the vast majority of newborn samples regardless of case or control status. However, the chemokine monocyte chemotactic protein-1 (MCP-1) was elevated and the chemokine Regulated upon Activation Normal T-Cell Expressed and Secreted (RANTES) was decreased in ASD cases compared to GP controls. The chemokines macrophage inflammatory protein-1alpha (MIP-1α) and RANTES were decreased in children with DD compared to GP controls.ConclusionMeasurement of immune system function in the first few days of life may aid in the early identification of abnormal neurodevelopment and shed light on the biologic mechanisms underlying normal neurodevelopment

Cross-genetic determination of maternal and neonatal immune mediators during pregnancy.

BACKGROUND:The immune system plays a fundamental role in development during pregnancy and early life. Alterations in circulating maternal and neonatal immune mediators have been associated with pregnancy complications as well as susceptibility to autoimmune and neurodevelopmental conditions in later life. Evidence suggests that the immune system in adults not only responds to environmental stimulation but is also under strong genetic control. METHODS:This is the first genetic study of > 700 mother-infant pairs to analyse the circulating levels of 22 maternal mid-gestational serum-derived and 42 neonatal bloodspot-derived immune mediators (cytokines/chemokines) in the context of maternal and fetal genotype. We first estimated the maternal and fetal genome-wide SNP-based heritability (h2g) for each immune molecule and then performed genome-wide association studies (GWAS) to identify specific loci contributing to individual immune mediators. Finally, we assessed the relationship between genetic immune determinants and ASD outcome. RESULTS:We show maternal and neonatal cytokines/chemokines displaying genetic regulation using independent methodologies. We demonstrate that novel fetal loci for immune function independently affect the physiological levels of maternal immune mediators and vice versa. The cross-associated loci are in distinct genomic regions compared with individual-specific immune mediator loci. Finally, we observed an interaction between increased IL-8 levels at birth, autism spectrum disorder (ASD) status, and a specific maternal genotype. CONCLUSIONS:Our results suggest that maternal and fetal genetic variation influences the immune system during pregnancy and at birth via distinct mechanisms and that a better understanding of immune factor determinants in early development may shed light on risk factors for developmental disorders

D-meson semileptonic decays to pseudoscalars from four-flavor lattice QCD

We present lattice-QCD calculations of the hadronic form factors for the semileptonic decays $D\to\pi\ell\nu$, $D\to K\ell\nu$, and $D_s\to K\ell\nu$. Our calculation uses the highly improved staggered quark (HISQ) action for all valence and sea quarks and includes $N_f=2+1+1$ MILC ensembles with lattice spacings ranging from $a\approx0.12$ fm down to $0.042$ fm. At most lattice spacings, an ensemble with physical-mass light quarks is included. The HISQ action allows all the quarks to be treated with the same relativistic light-quark action, allowing for nonperturbative renormalization using partial conservation of the vector current. We combine our results with experimental measurements of the differential decay rates to determine $|V_{cd}|^{D\to\pi}=0.2238(11)^{\rm Expt}(15)^{\rm QCD}(04)^{\rm EW}(02)^{\rm SIB}[22]^{\rm QED}$ and $|V_{cs}|^{D\to K}=0.9589(23)^{\rm Expt}(40)^{\rm QCD}(15)^{\rm EW}(05)^{\rm SIB}[95]^{\rm QED}$ This result for $|V_{cd}|$ is the most precise to date, with a lattice-QCD error that is, for the first time for the semileptonic extraction, at the same level as the experimental error. Using recent measurements from BES III, we also give the first-ever determination of $|V_{cd}|^{D_s\to K}=0.258(15)^{\rm Expt}(01)^{\rm QCD}[03]^{\rm QED}$ from $D_s\to K \ell\nu$. Our results also furnish new Standard Model calculations of the lepton flavor universality ratios $R^{D\to\pi}=0.98671(17)^{\rm QCD}[500]^{\rm QED}$, $R^{D\to K}=0.97606(16)^{\rm QCD}[500]^{\rm QED}$, and $R^{D_s\to K}=0.98099(10)^{\rm QCD}[500]^{\rm QED}$, which are consistent within $2\sigma$ with experimental measurements. Our extractions of $|V_{cd}|$ and $|V_{cs}|$, when combined with a value for $|V_{cb}|$, provide the most precise test of second-row CKM unitarity, finding agreement with unitarity at the level of one standard deviation.Comment: 92 page

Light-quark connected intermediate-window contributions to the muon g−2g-2 hadronic vacuum polarization from lattice QCD

We present a lattice-QCD calculation of the light-quark connected contribution to window observables associated with the leading-order hadronic vacuum polarization contribution to the anomalous magnetic moment of the muon, $a_\mu^{\mathrm{HVP,LO}}$. We employ the MILC Collaboration's isospin-symmetric QCD gauge-field ensembles, which contain four flavors of dynamical highly-improved-staggered quarks with four lattice spacings between $a\approx 0.06$-$0.15$~fm and close-to-physical quark masses. We consider several effective-field-theory-based schemes for finite-volume and other lattice corrections and combine the results via Bayesian model averaging to obtain robust estimates of the associated systematic uncertainties. After unblinding, our final results for the intermediate and ``W2'' windows are $a^{ll,{\mathrm W}}_{\mu}(\mathrm{conn.})=206.6(1.0) \times 10^{-10}$ and $a^{ll,\mathrm {W2}}_{\mu}(\mathrm{conn.}) = 100.7(3.2)\times 10^{-10}$, respectively

Dark sectors 2016 Workshop: community report

This report, based on the Dark Sectors workshop at SLAC in April 2016, summarizes the scientific importance of searches for dark sector dark matter and forces at masses beneath the weak-scale, the status of this broad international field, the important milestones motivating future exploration, and promising experimental opportunities to reach these milestones over the next 5-10 years