Group psychedelic therapy: empirical estimates of cost-savings and improved access

ObjectiveTo compare group and individual psychedelic-assisted therapy in terms of clinician time, costs and patient access.MethodsUsing 2023 data from two group therapy trial sites, one using 3,4-Methylenedioxymethamphetamine (MDMA) to treat posttraumatic stress disorder (PTSD), and one using psilocybin to treat major depressive disorder (MDD), we compared overall variable costs, clinician costs and clinician time required by therapy protocols utilizing groups versus individual patient therapy. Using published literature, we estimated the prevalence of adults with PTSD and MDD eligible for treatment with psychedelic therapy and projected the savings in time and cost required to treat these prevalent cases.ResultsGroup therapy saved 50.9% of clinician costs for MDMA-PTSD and 34.7% for psilocybin-MDD, or $3,467 and$981 per patient, respectively. To treat all eligible PTSD and MDD patients in the U.S. in 10 years with group therapy, 6,711 fewer full-time equivalent (FTE) clinicians for MDMA-PTSD and 1,159 fewer for FTE clinicians for psilocybin-MDD would be needed, saving up to $10.3 billion and$2.0 billion respectively, discounted at 3% annually.ConclusionAdopting group therapy protocols where feasible would significantly reduce the cost of psychedelic-assisted therapies. By enhancing the number of patients served per clinician, group therapy could also ameliorate the anticipated shortage of appropriately trained clinicians, thereby accelerating access to these promising new therapies

Healthcare Barriers of Refugees Post-resettlement

The majority of refugees spend the greater part of their lives in refugee camps before repatriation or resettlement to a host country. Limited resources and stress during residence in refugee camps can lead to a variety of acute and chronic diseases which often persist upon resettlement. However, for most resettled refugees little is known about their health needs beyond a health assessment completed upon entry. We conducted a qualitative pilot-study in San Diego County, the third largest area in California, USA for resettling refugees, to explore health care access issues of refugees after governmental assistance has ended. A total of 40 guided in-depth interviews were conducted with a targeted sample of informants (health care practitioners, employees of refugee serving organizations, and recent refugee arrivals) familiar with the health needs of refugees. Interviews revealed that the majority of refugees do not regularly access health services. Beyond individual issues, emerging themes indicated that language and communication affect all stages of health care access—from making an appointment to filling out a prescription. Acculturation presented increased stress, isolation, and new responsibilities. Additionally, cultural beliefs about health care directly affected refugees’ expectation of care. These barriers contribute to delayed care and may directly influence refugee short- and long-term health. Our findings suggest the need for additional research into contextual factors surrounding health care access barriers, and the best avenues to reduce such barriers and facilitate access to existing services

High-Precision Radio and Infrared Astrometry of LSPM J1314+1320AB - II: Testing Pre--Main-Sequence Models at the Lithium Depletion Boundary with Dynamical Masses

Trent J. Dupuy, et al, 'HIGH-PRECISION RADIO AND INFRARED ASTROMETRY OF LSPM J1314+1320AB. II. TESTING PREMAIN-SEQUENCE MODELS AT THE LITHIUM DEPLETION BOUNDARY WITH DYNAMICAL MASSES', The Astrophysical Journal, Vol. 827 (1), 14pp, August 2016. doi:10.3847/0004-637X/827/1/23. © 2016. The American Astronomical Society. All rights reserved.We present novel tests of pre$-$main-sequence models based on individual dynamical masses for the M7 binary LSPM J1314+1320AB. Joint analysis of our Keck adaptive optics astrometric monitoring along with Very Long Baseline Array radio data from a companion paper yield component masses of $0.0885\pm0.0006$ $M_{\odot}$ and $0.0875\pm0.0010$ $M_{\odot}$ and a parallactic distance of $17.249\pm0.013$ pc. We also derive component luminosities that are consistent with the system being coeval at an age of $80.8\pm2.5$ Myr, according to BHAC15 evolutionary models. The presence of lithium is consistent with model predictions, marking the first time the theoretical lithium depletion boundary has been tested with ultracool dwarfs of known mass. However, we find that the average evolutionary model-derived effective temperature ($2950\pm5$ K) is 180 K hotter than we derive from a spectral type$-$$T_{\rm eff}$ relation based on BT-Settl models ($2770\pm100$ K). We suggest that the dominant source of this discrepancy is model radii being too small by $\approx$13%. In a test that mimics the typical application of evolutionary models by observers, we derive masses on the H-R diagram using the luminosity and BT-Settl temperature. The estimated masses are $46^{+16}_{-19}$% (2.0$\sigma$) lower than we measure dynamically and would imply that this is a system of $\approx$50 $M_{\rm Jup}$ brown dwarfs, highlighting the large systematic errors possible when inferring masses from the H-R diagram. This is first time masses have been measured for ultracool ($\geq$M6) dwarfs displaying spectral signatures of low gravity. Based on features in the infrared, LSPM J1314+1320AB appears higher gravity than typical Pleiades and AB Dor members, opposite the expectation given its younger age. The components of LSPM J1314+1320AB are now the nearest, lowest mass pre$-$main-sequence stars with direct mass measurements.Peer reviewe

Seed dispersal by Ceratogymna hornbills in the Dja Reserve, Cameroon

Seed dispersal is a process critical to the maintenance of tropical forests, yet little is known about the interactions of most dispersers with their communities. In the Dja Reserve, Cameroon, seed dispersal by the hornbills Ceratogymna atrata, C. cylindricus and C. fistulator (Aves: Bucerotidae) was evaluated with respect to the taxonomic breadth of plants dispersed, location of seed deposition and effects on seed germination. Collectively, the three hornbill species consumed fruits from 59 tree and liana species, and likely provided dispersal for 56 of them. Hornbill-dispersed tree species composed 22% of the known tree flora of the site. Hornbill visit lengths, visit frequencies, and seed passage times indicated that few seeds were deposited beneath parent trees; in five hornbill/tree species pairings studied, 69–100% of the seeds ingested were deposited away from the parent trees. Germination trials showed that hornbill gut passage is gentle on seeds. Of 24 tree species tested, 23 germinated after passage by hornbills; of 17 planted with controls taken directly from trees, only four species showed evidence of inhibition of germination rate, while seven experienced unchanged germination rates and six experienced enhanced germination rates. Results suggested that Ceratogymna hornbills rank among the most important seed dispersers found in Afrotropical forests, and they deserve increased conservation attention. Ceratogymna hornbills are likely to become increasingly important in forest regeneration as populations of larger mammalian seed dispersers (such as forest elephants and primates) diminish.NYZS/The Wildlife Conservation Society, the National Science Foundation Graduate Fellowship Program, the GAANN Program of San Francisco State University, and ECOFAC Camerou

Association of FGFR1 with ERαmaintains ligand-independent ER transcription and mediates resistance to estrogen deprivation in ER+ breast cancer

FGFR1 amplification occurs in ~15% of ER+ human breast cancers. We investigated mechanisms by which FGFR1 amplification confers antiestrogen resistance to ER+ breast cancer.Experimental Design: ER+ tumors from patients treated with letrozole before surgery were subjected to Ki67 immunohistochemistry, FGFR1 FISH, and RNA-sequencing. ER+/FGFR1 amplified breast cancer cells and patient-derived xenografts (PDXs) were treated with FGFR1 siRNA or the FGFR tyrosine kinase inhibitor lucitanib. Endpoints were cell/xenograft growth, FGFR1/ERα association by co-immunoprecipitation and proximity ligation, ER genomic activity by ChIP-sequencing, and gene expression by RT-PCR.Results: ER+/FGFR1 amplified tumors in patients treated with letrozole maintained cell proliferation (Ki67). Estrogen deprivation increased total and nuclear FGFR1 and FGF ligands expression in ER+/FGFR1-amplified primary tumors and breast cancer cells. In estrogen-free conditions, FGFR1 associated with ERα in tumor cell nuclei and regulated the transcription of ER-dependent genes. This association was inhibited by a kinase-dead FGFR1 mutant and by treatment with lucitanib. ChIP-seq analysis of estrogen-deprived ER+/FGFR1 amplified cells showed binding of FGFR1 and ERα to DNA. Treatment with fulvestrant and/or lucitanib reduced FGFR1 and ERα binding to DNA. RNA-seq data from FGFR1-amplified patients' tumors treated with letrozole showed enrichment of estrogen response and E2F target genes. Finally, growth of ER+/FGFR1-amplified cells and PDXs was more potently inhibited by fulvestrant and lucitanib combined than each drug alone.Conclusions: These data suggest the ERα pathway remains active in estrogen-deprived ER+/FGFR1-amplified breast cancers. Therefore, these tumors are endocrine resistant and should be candidates for treatment with combinations of ER and FGFR antagonists

Epigenomic reprogramming during pancreatic cancer progression links anabolic glucose metabolism to distant metastasis

During the progression of pancreatic ductal adenocarcinoma (PDAC), heterogeneous subclonal populations emerge that drive primary tumor growth, regional spread, distant metastasis, and patient death. However, the genetics of metastases largely reflects that of the primary tumor in untreated patients, and PDAC driver mutations are shared by all subclones. This raises the possibility that an epigenetic process might operate during metastasis. Here we report large-scale reprogramming of chromatin modifications during the natural evolution of distant metastasis. Changes were targeted to thousands of large chromatin domains across the genome that collectively specified malignant traits, including euchromatin and large organized chromatin histone H3 lysine 9 (H3K9)-modified (LOCK) heterochromatin. Remarkably, distant metastases co-evolved a dependence on the oxidative branch of the pentose phosphate pathway (oxPPP), and oxPPP inhibition selectively reversed reprogrammed chromatin, malignant gene expression programs, and tumorigenesis. These findings suggest a model whereby linked metabolic epigenetic programs are selected for enhanced tumorigenic fitness during the evolution of distant metastasis