States' Roles in Shaping High Performance Health Systems

Analyzes results from the State Health Policies Aimed at Promoting Excellent Systems survey and a review of current research on efforts to improve state healthcare systems, with a focus on coverage; quality, safety, and value; and infrastructure

State Health Policies Aimed at Promoting Excellent Systems: A Report on States’ Roles in Health Systems Performance

States shape the health system in many ways: as purchasers, regulators, and conveners. Despite these various roles, there is little systematic effort to monitor state choices, learn from the choices states make, and purposefully spread one state’s innovations to other states. Coordination between states and the federal government on approaches to improving the health care system is often lacking, limiting our nation’s ability to address critical problems. In an effort to improve health system performance and increase the spread of innovation, the National Academy for State Health Policy (NASHP), with support from the Commonwealth Fund, prepared this report on a broad array of state health policies and practices. This report describes a tremendous amount of activity at the state level and which has implications for how well the health care system performs

In silico and in vitro drug screening identifies new therapeutic approaches for Ewing sarcoma.

The long-term overall survival of Ewing sarcoma (EWS) patients remains poor; less than 30% of patients with metastatic or recurrent disease survive despite aggressive combinations of chemotherapy, radiation and surgery. To identify new therapeutic options, we employed a multi-pronged approach using in silico predictions of drug activity via an integrated bioinformatics approach in parallel with an in vitro screen of FDA-approved drugs. Twenty-seven drugs and forty-six drugs were identified, respectively, to have anti-proliferative effects for EWS, including several classes of drugs in both screening approaches. Among these drugs, 30 were extensively validated as mono-therapeutic agents and 9 in 14 various combinations in vitro. Two drugs, auranofin, a thioredoxin reductase inhibitor, and ganetespib, an HSP90 inhibitor, were predicted to have anti-cancer activities in silico and were confirmed active across a panel of genetically diverse EWS cells. When given in combination, the survival rate in vivo was superior compared to auranofin or ganetespib alone. Importantly, extensive formulations, dose tolerance, and pharmacokinetics studies demonstrated that auranofin requires alternative delivery routes to achieve therapeutically effective levels of the gold compound. These combined screening approaches provide a rapid means to identify new treatment options for patients with a rare and often-fatal disease

No bursts detected from FRB121102 in two 5-hour observing campaigns with the Robert C. Byrd Green Bank Telescope

Here, we report non-detection of radio bursts from Fast Radio Burst FRB 121102 during two 5-hour observation sessions on the Robert C. Byrd 100-m Green Bank Telescope in West Virginia, USA, on December 11, 2017, and January 12, 2018. In addition, we report non-detection during an abutting 10-hour observation with the Kunming 40-m telescope in China, which commenced UTC 10:00 January 12, 2018. These are among the longest published contiguous observations of FRB 121102, and support the notion that FRB 121102 bursts are episodic. These observations were part of a simultaneous optical and radio monitoring campaign with the the Caltech HIgh- speed Multi-color CamERA (CHIMERA) instrument on the Hale 5.1-m telescope.Comment: 1 table, Submitted to RN of AA

Phenotypic and genetic integration of personality and growth under competition in the sheepshead swordtail, Xiphophorus birchmanni

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Competition for resources including food, physical space, and potential mates is a fundamental ecological process shaping variation in individual phenotype and fitness. The evolution of competitive ability, in particular social dominance, depends on genetic (co)variation among traits causal (e.g., behaviour) or consequent (e.g. growth) to competitive outcomes. If dominance is heritable, it will generate both direct and indirect genetic effects (IGE) on resource dependent traits. The latter are expected to impose evolutionary constraint because winners necessarily gain resources at the expense of losers. We varied competition in a population of sheepshead swordtails, Xiphophorus birchmanni, to investigate effects on behaviour, size, growth, and survival. We then applied quantitative genetic analyses to determine (i) whether competition leads to phenotypic and/or genetic integration of behaviour with life history and (ii) the potential for IGE to constrain life history evolution. Size, growth and survival were reduced at high competition. Male dominance was repeatable and dominant individuals show higher growth and survival. Additive genetic contributions to phenotypic covariance were significant, with the G matrix largely recapitulating phenotypic relationships. Social dominance has a low but significant heritability and is strongly genetically correlated with size and growth. Assuming causal dependence of growth on dominance, hidden IGE will therefore reduce evolutionary potential.This work was supported by an EPSRC Studentship to KB, a BBSRC David Phillips Fellowship to AJW and a BBSRC grant (BB/L022656/1). CAW was funded by a NERC post-doctoral Research Fellowship (NE/I020245/1) and a University of Edinburgh Chancellor’s Fellowship. GGR was funded by the U.S. National Science Foundatio