Massachusetts Medicaid: Innovative Fiscal Strategies, The Public Partnership Model

This report provides a snapshot of the innovative programs UMass Medical School’s Center for Health Care Financing has initiated and conducted on behalf of the Commonwealth of Massachusetts. You will see how we have been able to generate revenue and achieve cost avoidance totaling $26 billion over the past 15 years. And while the numbers are impressive, especially in increasingly difficult fiscal times, the more important story is what can be accomplished when the family of state agencies in Massachusetts collaborate and combine their strengths to better serve the public. The public partnership model offers states the flexibility to adapt their programs in changing times, administrative efficiencies that optimize resources, and an environment where innovation is achievable. The considerable cost savings achieved by working with a public partner provides states with additional funds to improve the lives of its citizens, especially those who are most vulnerable and in need of support. We are proud of our accomplishments, and we believe they affirm our ongoing commitment to public service and fulfill our vision of providing underserved populations access to quality health care

Alien Registration- Thibodeau, Mary A. (Bangor, Penobscot County)

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Effects of Orally Administered Allopurinol (Hyroxyprazolo 3,4-d pyrimidine) on Uric Acid, Selected Blood Lipid and Hemogram Parameters in Rabbits

Gout is one of the earliest disease entities to be described in medical writings. Hippocrates noted familial distribution patterns and described its classic symptomatology in the 5th century B.C. Empirical treatment employing colchicine was advocated by Alexander of Tralles in the 5th century A.D. A better understanding of the complex association between clinical manifestations of gout and uric acid, carbohydrate and lipid metabolism has made rational treatment possible only very recently. Ample experimental and clinical data now available show a definite association between disorders of purine metabolism resulting in hyperuricemia and frequent concomitant hyperlipidemia. A high incidence of both hypercholesterolemia and hypertriglyceridemia has been documented. Elevated serum lipids may explain, in part, clinical manifestations of atherosclerosis, occlusive peripheral and coronary arterial disease and vascular nephrosclerosis so common in approximately 800,000 individuals suffering from gout in the United States. Renal failure, ischemic and degenerative cardiovascular disease are the most common cause of: death in these patients. Therefore, the need for safe and reliable drugs that may be employed in the rational treatment of both gout, and associated cardiovascular alterations is abundantly clear. Allopurinol (hydroxypyrazolo(3,4-d)pyrimidine) (HPP) is by far the most promising drug now available for treatment of gout and related hyperuricemic disorders. It represents a new and rational approach to therapy by inhibiting an enzyme essential to uric acid biosynthesis. The correlation between gout and clinical manifestations of atherosclerosis associated with hypercholesterolemia and hypertriglyceridemia dictates that drugs used in treating hyperuricemic conditions should not elevate serum lipids. A further elevation of these parameters could increase the incidence of cardiovascular disease in highly susceptible gouty subjects. A possible causal relationship between therapeutic use of allopurinol and elevations· in blood lipid values (human subject) was reported for the first time by this station in April, 1969. A subsequent preliminary animal study indicated an apparent experimentally provoked hypercholesterolemic hyperlipemia in rabbits administered allopurinol. This study was initiated to examine the problem in greater detail

Effects of Orally Administered Sodium D-thyroxine upon Pregnancy Progression in Euthyroid Rabbits and its Effect Upon the Newborn

Many authorities believe that prophylactic treatment of idiopathic hypercholesterolemia will prevent atherosclerosis and plaque formation which almost always precedes clinical arteriosclerosis and subsequent degenerative heart disease. There has been intensive research investigation initiated to provide a pharmacologic agent that will lower elevated serum cholesterol levels in mammals including humans. Several hypocholesterolemic drugs are being tested at the present time, one of the most promising is the dextro-rotary isomer of thyroxine. This study was conducted not only to determine the effects of orally administered dextrothyroxine on pregnancy progression, but also to provide information for further investigations concerning alterations related to hypercholesterolemic pregnant animals. Cardiovascular diseases are by far the leading cause of death in the Western World. Therefore, the need for safe and reliable drugs that might be employed in the prevention and/or treatment of cardiovascular alterations is abundantly clear. Presently, within the United States, three hypocholesterolemic agents are being tested in massive clinical trials: nicotinic acid, ethyl p-chlorophenosyisobutyrate1 and sodium D-thyroxine2, of which D-thyroxine is the most promising. Almost nothing is known concerning the alterations of D-thyroxine in relation to pregnancy progression or its effects involving newborn mammals and/or humans. The possibility of congenital cardiac anamolies must, however, be considered in the light of previous research investigations which indicate that cardiac hypertrophy may occur during D-thyroxine administration. It is hoped that these investigations coupled with the contemplative studies utilizing hypercholesterolemic animals may shed some light on possible cardiovascular alterations caused by D-thyroxine administration during pregnancy.

Building and Sustaining University-Medicaid Partnerships When State Governments Change

Growing a successful and sustainable partnership between a public university and a state’s Medicaid-financed health and human service agency is an enviable goal. These types of partnerships were envisioned by the original drafters of the Medicaid law and supported by the regulations that have framed the program. However, any partnership that joins two complex and bureaucratic organizations relies upon the infrastructure created to support it and the resiliency of the people who make it work. This issue brief from Public University Medicaid Partnerships describes the challenges public universities and state Medicaid agencies face in creating partnerships, and discusses methods and recommendations to make it happen. The brief is authored by Marc A. Thibodeau, J.D., M.S., Executive Director, Center for Health Care Financing at UMass Medical School, and Jerry Friedman, J.D., Advisor for Health Policy and Associate Vice President for External Relations & Advocacy, The Ohio State University Medical Center

Impact of Arctic shelf summer stratification on Holocene climate variability

Accepted manuscript version, licensed CC BY-NC-ND 4.0. Published version available at: http://doi.org/10.1016/j.quascirev.2018.05.017Understanding the dynamic of freshwater and sea-ice export from the Arctic is crucial to better comprehend the potential near-future climate change consequences. Here, we report nitrogen isotope data of a core from the Laptev Sea to shed light on the impact of the Holocene Siberian transgression on the summer stratification of the Laptev Sea. Our data suggest that the oceanographic setting was less favourable to sea-ice formation in the Laptev Sea during the early to mid-Holocene. It is only after the sea level reached a standstill at around 4 ka that the water column structure in the Laptev Sea became more stable. Modern-day conditions, often described as “sea-ice factory”, were reached about 2 ka ago, after the development of a strong summer stratification. These results are consistent with sea-ice reconstruction along the Transpolar Drift, highlighting the potential contribution of the Laptev Sea to the export of freshwater from the Arctic Ocean

The Dynamics of State University Participation in State Medicaid Administration

It is not uncommon for state university faculty to participate as part-time consultants in the administration of state Medicaid programs. However, rarely do state universities participate institutionally as public agencies in the administration of state Medicaid programs since the propriety, value and parameters of these engagements are usually not recognized. Even in states where they flourish, collaborations between state universities and state Medicaid agencies are not well understood and suggest to some people an unlikely confluence of two worlds. The missions of state universities and state Medicaid programs differ, their institutional cultures differ, and their protocols differ. In all states, state universities are considered apart from other state agencies, sometimes to the point of not being thought of as state agencies at all. Yet, the appropriateness and benefits of state universities engaging in Medicaid administration have been well established by state universities and the state Medicaid programs that have worked together. In light of the challenges facing state Medicaid programs and what state universities can do for these programs, state universities contributing to Medicaid administration should be more recognized and more common. Explanation and examples follow. Rounding out this discussion will be depictions of collaborations in three states: Maryland, Massachusetts and Ohio. Maryland’s initiative spotlights analytic, program development and program evaluation services; Massachusetts’ features clinical expertise; and, Ohio’s dwells on workforce development. In all three states, the state university partner does far more for Medicaid than is covered here, but these examples suggest the breadth of what state universities can do

Unnesting of Copatterns

Inductive data such as finite lists and trees can elegantly be defined by constructors which allow programmers to analyze and manipulate finite data via pattern matching. Dually, coinductive data such as streams can be defined by observations such as head and tail and programmers can synthesize infinite data via copattern matching. This leads to a symmetric language where finite and infinite data can be nested. In this paper, we compile nested pattern and copattern matching into a core language which only supports simple non-nested (co)pattern matching. This core language may serve as an intermediate language of a compiler. We show that this translation is conservative, i.e. the multi-step reduction relation in both languages coincides for terms of the original language. Furthermore, we show that the translation preserves strong and weak normalisation: a term of the original language is strongly/weakly normalising in one language if and only if it is so in the other. In the proof we develop more general criteria which guarantee that extensions of abstract reduction systems are conservative and preserve strong or weak normalisation. \ua9 2014 Springer International Publishing Switzerland

Diel Vertical Distribution Patterns of Zooplankton along the Western Antarctic Peninsula

The Western Antarctic Peninsula (WAP) is a region that has undergone significant change over the past several decades due to unprecedented increases sea surface temperature and decreases in sea ice cover. The ongoing Palmer Antarctica Long-Term Ecological Research (PAL LTER) study shows that these environmental changes are significantly affecting the marine pelagic ecosystem along the WAP. The goal of this study was to analyze diel vertical distribution patterns of zooplankton along the WAP