The Burden of a Good Idea: Examining the Impact of Unfunded Federal Regulatory Mandates on Medicare Participating Hospitals

Health care costs are on the rise. In 1960, the United States spent $9 billion on hospital care. Since then, hospital related spending has grown exponentially. In 2015, the United States spent over$1 trillion on hospital care, with $359.9 billion of those payments coming from the federal Medicare program for the aged and disabled. Researchers have long tried to understand the exact causes of rising health care costs. While many have closely examined the costs associated with population demographics, medical innovation, prescription drug costs, overutilization of services, and fraud or abuse, there is one driving force that does not receive sufficient attention-federal regulatory burden. Hospitals and other health care providers that participate in the Medicare program are heavily regulated by over thirty different federal agencies. While the primary goal of these regulatory efforts is to protect patient safety and promote access to quality health care services, the burden imposed by these regulatory efforts is both substantial and unsustainable. One recent report estimated administrative costs, including the costs of adopting and complying with health care regulations, now account for over twenty-five percent of annual hospital spending in the United States, or more than$215 billion a year. Further, a recent study by the American Hospital Association (AHA) noted that [a]n average sized community hospital now spends nearly over $7.6 million annually to support compliance with ... federal regulations

Just What the Doctor Ordered: Is It Time for Your Bank to Start Offering a Health Savings Account (HSA)? Here\u27s What You Need to Know About This New Product

In recent years. The ever-increasing cost of health insurance has left many consumers and employers desperate for lower-cost coverage options. As a result, employers are moving away from expensive defined-benefit plans to alternatives that offer higher deductibles in exchange for a reduction in premium costs. The health savings account (HSA) grew out of this quest for choice. The HSA was designed as a tax-efficient way for consumers with high-deductible plans to pay for health costs accrued before the insurance kicked in. These high-deductible plans are touted as being more affordable for both employers and consumers as well as for having the potential to reduce the number of uninsured and underinsured Americans

Comparative ICE Genomics: Insights into the Evolution of the SXT/R391 Family of ICEs

Integrating and conjugative elements (ICEs) are one of the three principal types of self-transmissible mobile genetic elements in bacteria. ICEs, like plasmids, transfer via conjugation; but unlike plasmids and similar to many phages, these elements integrate into and replicate along with the host chromosome. Members of the SXT/R391 family of ICEs have been isolated from several species of gram-negative bacteria, including Vibrio cholerae, the cause of cholera, where they have been important vectors for disseminating genes conferring resistance to antibiotics. Here we developed a plasmid-based system to capture and isolate SXT/R391 ICEs for sequencing. Comparative analyses of the genomes of 13 SXT/R391 ICEs derived from diverse hosts and locations revealed that they contain 52 perfectly syntenic and nearly identical core genes that serve as a scaffold capable of mobilizing an array of variable DNA. Furthermore, selection pressure to maintain ICE mobility appears to have restricted insertions of variable DNA into intergenic sites that do not interrupt core functions. The variable genes confer diverse element-specific phenotypes, such as resistance to antibiotics. Functional analysis of a set of deletion mutants revealed that less than half of the conserved core genes are required for ICE mobility; the functions of most of the dispensable core genes are unknown. Several lines of evidence suggest that there has been extensive recombination between SXT/R391 ICEs, resulting in re-assortment of their respective variable gene content. Furthermore, our analyses suggest that there may be a network of phylogenetic relationships among sequences found in all types of mobile genetic elements

A scalable solution for isolating human multipotent clinical-grade neural stem cells from ES precursors.

BackgroundA well-characterized method has not yet been established to reproducibly, efficiently, and safely isolate large numbers of clinical-grade multipotent human neural stem cells (hNSCs) from embryonic stem cells (hESCs). Consequently, the transplantation of neurogenic/gliogenic precursors into the CNS for the purpose of cell replacement or neuroprotection in humans with injury or disease has not achieved widespread testing and implementation.MethodsHere, we establish an approach for the in vitro isolation of a highly expandable population of hNSCs using the manual selection of neural precursors based on their colony morphology (CoMo-NSC). The purity and NSC properties of established and extensively expanded CoMo-NSC were validated by expression of NSC markers (flow cytometry, mRNA sequencing), lack of pluripotent markers and by their tumorigenic/differentiation profile after in vivo spinal grafting in three different animal models, including (i) immunodeficient rats, (ii) immunosuppressed ALS rats (SOD1G93A), or (iii) spinally injured immunosuppressed minipigs.ResultsIn vitro analysis of established CoMo-NSCs showed a consistent expression of NSC markers (Sox1, Sox2, Nestin, CD24) with lack of pluripotent markers (Nanog) and stable karyotype for more than 15 passages. Gene profiling and histology revealed that spinally grafted CoMo-NSCs differentiate into neurons, astrocytes, and oligodendrocytes over a 2-6-month period in vivo without forming neoplastic derivatives or abnormal structures. Moreover, transplanted CoMo-NSCs formed neurons with synaptic contacts and glia in a variety of host environments including immunodeficient rats, immunosuppressed ALS rats (SOD1G93A), or spinally injured minipigs, indicating these cells have favorable safety and differentiation characteristics.ConclusionsThese data demonstrate that manually selected CoMo-NSCs represent a safe and expandable NSC population which can effectively be used in prospective human clinical cell replacement trials for the treatment of a variety of neurodegenerative disorders, including ALS, stroke, spinal traumatic, or spinal ischemic injury

A scalable solution for isolating human multipotent clinical-grade neural stem cells from ES precursors

Abstract Background A well-characterized method has not yet been established to reproducibly, efficiently, and safely isolate large numbers of clinical-grade multipotent human neural stem cells (hNSCs) from embryonic stem cells (hESCs). Consequently, the transplantation of neurogenic/gliogenic precursors into the CNS for the purpose of cell replacement or neuroprotection in humans with injury or disease has not achieved widespread testing and implementation. Methods Here, we establish an approach for the in vitro isolation of a highly expandable population of hNSCs using the manual selection of neural precursors based on their colony morphology (CoMo-NSC). The purity and NSC properties of established and extensively expanded CoMo-NSC were validated by expression of NSC markers (flow cytometry, mRNA sequencing), lack of pluripotent markers and by their tumorigenic/differentiation profile after in vivo spinal grafting in three different animal models, including (i) immunodeficient rats, (ii) immunosuppressed ALS rats (SOD1G93A), or (iii) spinally injured immunosuppressed minipigs. Results In vitro analysis of established CoMo-NSCs showed a consistent expression of NSC markers (Sox1, Sox2, Nestin, CD24) with lack of pluripotent markers (Nanog) and stable karyotype for more than 15 passages. Gene profiling and histology revealed that spinally grafted CoMo-NSCs differentiate into neurons, astrocytes, and oligodendrocytes over a 2–6-month period in vivo without forming neoplastic derivatives or abnormal structures. Moreover, transplanted CoMo-NSCs formed neurons with synaptic contacts and glia in a variety of host environments including immunodeficient rats, immunosuppressed ALS rats (SOD1G93A), or spinally injured minipigs, indicating these cells have favorable safety and differentiation characteristics. Conclusions These data demonstrate that manually selected CoMo-NSCs represent a safe and expandable NSC population which can effectively be used in prospective human clinical cell replacement trials for the treatment of a variety of neurodegenerative disorders, including ALS, stroke, spinal traumatic, or spinal ischemic injury

Delineation of the integrase-attachment and origin-of-transfer regions of the symbiosis island ICEMlSymR7A.

Integrative and conjugative elements (ICEs) are chromosomally-integrated mobile genetic elements that excise from their host chromosome and transfer to other bacteria via conjugation. ICEMlSymR7A is the prototypical member of a large family of "symbiosis ICEs" which confer upon their hosts the ability to form a nitrogen-fixing symbiosis with a variety of legume species. Mesorhizobial symbiosis ICEs carry a common core of mobilisation genes required for integration, excision and conjugative transfer. IntS of ICEMlSymR7A enables recombination between the ICEMlSymR7A attachment site attP and the 3' end of the phe-tRNA gene. Here we identified putative IntS attP arm (P) sites within the attP region and demonstrated that the outermost P1 and P5 sites demarcated the minimal region for efficient IntS-mediated integration. We also identified the ICEMlSymR7A origin-of-transfer (oriT) site directly upstream of the relaxase-gene rlxS. The ICEMlSymR7A conjugation system mobilised a plasmid carrying the cloned oriT to Escherichia coli in an rlxS-dependent manner. Surprisingly, an in-frame, markerless deletion mutation in the ICEMlSymR7A recombination directionality factor (excisionase) gene rdfS, but not a mutation in intS, abolished mobilisation, suggesting the rdfS deletion tentatively has downstream effects on conjugation or its regulation. In summary, this work defines two critical cis-acting regions required for excision and transfer of ICEMlSymR7A and related ICEs

Caracterização morfocultural, biossíntese de autoindutor e formação de biofilme por rizobactérias de hortaliças Morphocultural characterization, autoinducer biosynthesis and biofilm formation in rhizobacteria isolated from vegetable crops

O objetivo deste trabalho foi caracterizar e agrupar rizobactérias, isoladas de hortaliças, quanto à morfologia cultural, riqueza e diversidade e avaliar a biossíntese de autoindutores N-acil lactonas homoserinas (ALH) e a capacidade de formação de biofilmes. Sete estirpes também foram avaliadas quanto ao potencial de promoção de crescimento de Brassica oleraceae var. acephala em casa de vegetação. Para verificar a produção de ALH, foram realizados ensaios com Agrobacterium tumefaciens estirpe NT1 como sistema repórter. A formação de biofilme foi avaliada pelo cultivo do isolado em meio líquido. A promoção do crescimento foi avaliada após inoculação das estirpes em plantas de couve-de-folha pela determinação da produção de massa de matérias fresca e seca. A maior diversidade morfocultural foi encontrada entre as estirpes isoladas de couve-de-folha. De um total de 112 estirpes testadas, 13% foram positivas quanto à produção de ALH; de 91 estirpes, 96% foram capazes de formar biofilmes; e de 79 estirpes, 11% foram positivas para ambas as características. Foram observadas diferenças significativas na massa de matéria seca das raízes com inoculação de 10(9) UFC mL-1 da estirpe R142, que incrementou em 55% a massa de matéria seca das raízes de couve, em relação ao controle. Não há relação entre a capacidade de formar biofilme e a detecção de ALH produzidos pelas rizobactérias avaliadas.<br>The objective of this work was to characterize and group rhizobacteria isolated from vegetable crops for culture morphology, richness and diversity, and to evaluate the biosynthesis of N-acyl homoserine lactone (AHL) autoinducers and the capacity to form biofilms. Seven strains were also assessed for their potential to promote plant growth of Brassica oleraceae var. acephala in greenhouse. To test the production of AHL, the indicator strain Agrobacterium tumefaciens NT1 was used. The formation of biofilms was evaluated by cultivating the isolates in liquid medium. Growth promotion was evaluated after the inoculation of the strains in kale plants and through determination of the fresh and dry mass production. The largest morphocultural diversity was found among the strains isolated from kale. From a total of 112 tested strains, 13% were positive for AHL production, among 91 strains, 96% were capable to form biofilms, and among 79 strains, 11% were positive for both characteristics. Significant differences were observed in root dry mass of plants inoculated with 10(9) UFC mL-1 of strain R142 that increased in 55% the root dry mass in comparison to the control. There is no relationship between the capacity to form biofilms and the detection of the AHL produced by the evaluated rhizobacteria

Exopolysaccharide production in Caulobacter crescentus: A resource allocation trade-off between protection and proliferation

Complex and interacting selective pressures can produce bacterial communities with a range of phenotypes. One measure of bacterial success is the ability of cells or populations to proliferate while avoiding lytic phage infection. Resistance against bacteriophage infection can occur in the form of a metabolically expensive exopolysaccharide capsule. Here, we show that in Caulobacter crescentus, presence of an exopolysaccharide capsule provides measurable protection against infection from a lytic paracrystalline S-layer bacteriophage (CR30), but at a metabolic cost that reduces success in a phage-free environment. Carbon flux through GDP-mannose 4,6 dehydratase in different catabolic and anabolic pathways appears to mediate this trade-off. Together, our data support a model in which diversity in bacterial communities may be maintained through variable selection on phenotypes utilizing the same metabolic pathway