Improving the quality of life of people with advanced respiratory disease and severe breathlessness

Advanced respiratory disease imposes a greater symptom burden than many cancers but not does have comparable recognition of the need for supportive and palliative care or the infrastructure for its systematic delivery. Consequently, many people with advanced respiratory disease (and those closest to them) have a poor quality of life, disabled by chronic breathlessness, fatigue and other symptoms. They are socially isolated by the consequences of long-term illness and are often financially impoverished. The past decade has seen an increasing realisation that care for this group must improve and that symptom management must be prioritised. Clinical guidelines recommend person-centred care, including access to supportive and palliative care as needed, as part of standard medical practice. Advanced lung disease clinics and specialist breathlessness services (pioneered within palliative care) are developing within respiratory medicine services but are provided inconsistently. This review covers the comprehensive assessment of the patient with advanced respiratory disease, the importance of supporting carers and the current best practice in the management of breathlessness, fatigue and cough. It also suggests ways to incorporate person-centred care into the general respiratory clinic, assisted by better liaison with specialist palliative and primary care. Emerging evidence shows that excellent symptom management leads to better clinical outcomes and reduces inappropriate use of emergency medical services

The effectiveness of needle exchange programs in the United States and West Virginia

Needle Exchange Programs (NEPs) have been controversial aspects of public health care due to conflicting beliefs and opinions for public policies. NEPs have allowed Injection Drug Users the ability to exchange their used equipment for clean, unused supplies. Research into the effectiveness of needle exchange programs and the impact it has had on the reduction of HIV and viral hepatitis infections in people who inject drugs. Injection Drug Users have accounted for 10% of HIV transmission cases in West Virginia, and this state has been ranked as the highest in the whole United States for incidents of Hepatitis C. NEPs have had success at decreasing the number of individuals sharing syringes and spreading diseases. Because NEPs are recent initiatives, further research is needed to determine their full effect on lowering the rate of infection spread

Openness Personality Trait Associated With Benefit From a Nonpharmacological Breathlessness Intervention in People With Intrathoracic Cancer: An Exploratory Analysis

Context: Breathlessness is common in people with lung cancer. Nonpharmacological breathlessness interventions reduce distress because of and increase mastery over breathlessness. Objectives: Identify patient characteristics associated with response to breathlessness interventions. Methods: Exploratory secondary trial data analysis. Response defined as a one-point improvement in 0–10 Numerical Rating Scale of worst breathlessness/last 24 hours (response—worst) or a 0.5-point improvement in the Chronic Respiratory Questionnaire (CRQ) mastery (response—mastery) at four weeks. Univariable regression explored relationships with plausible demographic, clinical, and psychological variables followed by multivariable regression for associated (P < 0.05) variables. Results: About 158 participants with intrathoracic cancer (mean age 69.4 [SD 9.35] years; 40% women) were randomized to one or three breathlessness training sessions. About 91 participants had evaluable data for response—worst and 107 for response—mastery. In the univariable analyses, the personality trait openness was associated with response—worst (odds ratio [OR] 1.99 [95% CI 1.08–3.67]; P = 0.028) and response—mastery (OR 1.84 [95% CI 1.04–3.23]; P = 0.035). Higher CRQ—fatigue (OR 0.61 [95% CI 0.41–0.91]; P = 0.015), CRQ—emotion (OR 0.68 [95% CI 0.47–0.96]; P = 0.030), and worse CRQ—mastery (OR 0.61 [95% CI 0.42–0.88]; P = 0.008), and the presence of metastases and fatigue were associated with reduced odds of response—mastery. In the adjusted response—mastery model, only openness remained (OR 1.73 [95% CI 0.95–3.15]; P = 0.072). Conclusion: Worse baseline health, worse breathlessness mastery, but not severity, and openness were associated with a better odds of response. Breathlessness services must be easy to access, and patients should be encouraged and supported to attend

Medicaid and Case Management to Promote Healthy Child Development

This policy brief presents options for financing and delivering case management services to low-income and special-needs children in Medicaid. The analysis builds on a literature review of case management, a review of the legal underpinnings of Medicaid case management, and consultation with experts in the fields of health care finance and program operations. It aims to inform the policy community about the importance of case management for assuring the health and development of our youngest and most vulnerable children

Plant Community Response to Regional Sources of Dominant Grasses in Grasslands Restored Across a Longitudinal Gradient

Restorations in the light of climate change will need to take into account whether or not sources of the dominant plants are adapted to the future conditions at a site. In addition, the effect of these dominants, especially if sourced from outside the local area, on the assembling plant community needs assessment. We investigated how different ecotypes of the tallgrass prairie dominants Andropogon gerardii and Sorghastrum nutans affect assembling prairie communities. Four reciprocal common garden experiments were established across a longitudinal climate gradient characterized by a decrease in aridity in western Kansas (COLBY), central Kansas (HAYS), eastern Kansas (MANHATTAN), and southern Illinois (CARBONDALE). At each site, plots were seeded with ecotypes of A. gerardii and S. nutans sourced from central Kansas (CKS), eastern Kansas (EKS), southern Illinois (SIL), or a mix of all three regional ecotypes (MIX). All plots were also seeded with the same suite of seven subordinate species. Species composition was measured during the fourth year of restoration. The greatest variation between communities occurred at HAYS and CARBONDALE between plots seeded with CKS and SIL ecotypes. At these sites, plots seeded with the local source had the lowest diversity and cover of nondominant species. Compositional variation between plots seeded with different dominant grass ecotypes was found exclusively at CARBONDALE between CKS and SIL plots. Differences between locally seeded plots and plots seeded with a MIX of dominant grass ecotypes were contingent upon site. At CARBONDALE, MIX seeded plots had higher diversity than SIL ecotype plots. Our results indicate that across a wide geographic precipitation gradient, limited but important differences in community assembly occur in restorations established with different ecotypes of the dominant grasses. However, our results also support the use of mixtures of nonlocal ecotypes of dominant grasses in restorations without risk to the assembling plant community. Future studies need to determine the potential for out- breeding effects among seed sources in mixed stands

Noxious and Selected Invasive Plant Populations along Illinois Toll Highway Rights-of-Way

• Repeated a 2010 survey for selected invasive species and listed noxious weeds throughout the ISTHA corridor. • Mapped 1345 populations of invasive species. • Found the ISTHA corridor to be heavily populated by invasive species throughout the length of each roadway. • Most frequently found species were Canada Thistle (Cirsium arvense) and Cut-leaf Teasel (Dipsacus laciniatus). • Recommend management specific to each of 8 species or groups of species found during the survey.Illinois State Toll Highway Authorityunpublishednot peer reviewedOpe

Mental Illness and Addiction Disorder Treatment and Prevention

This Special Report of Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts (2d Ed.) analyzes Medicaid managed care contract provisions related to mental illness and addiction disorders (MI/AD). The analysis is based on 54 contracts and related documents (including 12 managed behavioral health care contracts) which were in effect as of the beginning of 1997. While this Special Report considers Medicaid contracts, its findings have implications for other public purchasers of managed care services for persons with MI/AD because, like Medicaid, other sources of third-party financing have traditionally supported services and activities that may not be part of the custom of the insurance industry. If these coverage and service practices are not specified in contracts, they may be lost

Identification of antiviral roles for the exon-junction complex and nonsense-mediated decay in flaviviral infection.

West Nile virus (WNV) is an emerging mosquito-borne flavivirus, related to dengue virus and Zika virus. To gain insight into host pathways involved in WNV infection, we performed a systematic affinity-tag purification mass spectrometry (APMS) study to identify 259 WNV-interacting human proteins. RNA interference screening revealed 26 genes that both interact with WNV proteins and influence WNV infection. We found that WNV, dengue and Zika virus capsids interact with a conserved subset of proteins that impact infection. These include the exon-junction complex (EJC) recycling factor PYM1, which is antiviral against all three viruses. The EJC has roles in nonsense-mediated decay (NMD), and we found that both the EJC and NMD are antiviral and the EJC protein RBM8A directly binds WNV RNA. To counteract this, flavivirus infection inhibits NMD and the capsid-PYM1 interaction interferes with EJC protein function and localization. Depletion of PYM1 attenuates RBM8A binding to viral RNA, suggesting that WNV sequesters PYM1 to protect viral RNA from decay. Together, these data suggest a complex interplay between the virus and host in regulating NMD and the EJC