Back to the Future: The Future of Long-Term Care in Massachusetts

The state of Massachusetts, like the rest of the United States, is facing an approaching crisis in long-term care. Over the next few decades the number of Massachusetts residents age 65 and older will soar. As these numbers increase, so will the need for long-term care. Massachusetts is ill prepared to provide the services that will be needed. Our current system of health care benefits leaves many elders with gaps in coverage. Those individuals who need long-term services often impoverish themselves and their spouses before the state pays for their care. Others languish on waiting lists to receive services. Our current provider supply and direct care workforce is inadequate to meet the needs of today\u27s elders, let alone cope with an increase in care needs. Although the state currently spends hundreds of millions of dollars on long-term care services provided by the MassHealth Program and the Home Care Program, providers are often reimbursed at below cost. We must reassess and plan for our future needs before the current problems in long-term care become a crisis. Following is a list of recommendations to improve our long-term care system and to address the coming surge in elder demographics. The recommendations are grouped by subject area and address a wide range of systemic issues. The one overriding concern of the authors is the need for better public education about long-term care and the programs and services that are available to those in need. Until elders and their families have a better understanding of the system and its alternatives, it will not be possible for individuals to plan thoughtfully for their care needs

Building Civic Capacity for College Students: Flexible Thinking and Communicating as Puppeteers, Community Partners, and Citizen-Leaders

College students face a complex world filled with pervasive social problems that require strong knowledge bases, critical thinking abilities, and sustained engagement in civic life. This article details key pedagogical practices for our innovative health puppetry program, in which undergraduate honors students use puppets to share information about healthy eating, diabetes prevention, and active lifestyles with children and their families in community settings. We articulate a notion of “flexible thinking� as the ability to take on and perform new roles within the public/civic arena by seeing complex social problems from multiple perspectives and responding with creative solutions and engaged action. We look to the written reflections of our student puppeteers to share, in their own words, multiple ways their thinking and communication changed as they grew as puppeteers, community partners, and citizen-leaders. We also offer insights about promoting flexible thinking through in-depth service-learning

Predictors of Student Success in an Entry-Level Baccalaureate Dental Hygiene Program

PURPOSE: The purpose of this study was to measure the utility of various predictors used by the Old Dominion University Gene W. Hirschfeld School of Dental Hygiene baccalaureate degree dental hygiene program in selecting dental hygiene students who are most likely to graduate and be successful in passing the National Board Dental Hygiene Examination (NBDHE). The following factors were examined: grade point average (GPA); science GPA; final grade in various prerequisite courses; final grade in first-year dental hygiene courses; academic setting where prerequisite courses were completed; multiple attempts to achieve a passing course grade; and admissions criteria points (ACP). METHODS: The sample selected for study consisted of the academic records of dental hygiene students admitted to the program from 1998 to 2002 (n = 235), who would have been eligible to take the NBDHE from 2000 to 2004. Data were analyzed using multiple logistic regression to determine success as measured by graduation (n = 146). With NBDHE as the criterion variable, data were analyzed using the multiple linear regression to determine successful entry into the profession (n = 130); significance was predetermined at the 0.05 level. RESULTS: Data analysis revealed that final course grade in oral pathology was a significant predictor of successful graduation (P = 0.0008). Variables that predicted NBDHE success were final course grade in oral pathology, final course grade in oral anatomy and histology, and the ACP rating (P \u3c .0001, P \u3c .0001, and P = .0245, respectively). There was no statistically significant relationship for other variables. CONCLUSION: Final grades in oral pathology and oral anatomy and histology can significantly predict graduation and NBDHE success at this institution, suggesting that educators look to improving student performance after admission to the program to improve the likelihood of success. Additionally, when this institution\u27s admission variables were combined into a cluster of variables (ACP), they proved significant at predicting success

Lifetime corneal edema load model

Purpose: To highlight the potential benefits for long-term use of silicone hydrogels daily disposable (DD) contact lenses, particularly with patients who are noncompliant, sleeping or napping while wearing their lenses, or those who have higher oxygen demands and wear this modality for decades. Methods: Published data for corneal swelling with lenses and no lens wear were used to develop a nonlinear least squares model. The edema load experienced with a range of oxygen transmissibilities (Dk/t) and wear compliance (sleep and napping) was determined. A mixed-effects linear regression model was used to compare the edema load for high and average corneal swellers. Results: The edema load generated demonstrates that a high Dk/t silicone hydrogel lens results in edema levels close to that with no lens wear. In comparison, hydrogels with a Dk/t of 27 (×10−9 [cm mL{O2}][s mLmmHg]), worn on a daily wear schedule will result in 1.5 times more edema and up to two times more if the patient is noncompliant over each decade of wear. High swellers after four decades of wear will have an edema load 10 to 17 times greater than average swellers depending on Dk/t and their degree of noncompliance with the daily wear modality. Conclusions: Prescribing silicone hydrogelDDlenses, particularly with higher DK/t,may help to maintain the long-term ocular health of patients, when they wear their lenses fulltime for many decades. Translational Relevance: Illustrates the importance of Dk/t for any CL wear modality where patients nap or sleep in lenses or have high oxygen needs

Planting sustainable seeds in young minds: the need to teach planetary health to children.

No abstract available

EMQN:Recommendations for genetic testing in inherited cardiomyopathies and arrhythmias

Inherited cardiomyopathies and arrhythmias (ICAs) are a prevalent and clinically heterogeneous group of genetic disorders that are associated with increased risk of sudden cardiac death and heart failure. Making a genetic diagnosis can inform the management of patients and their at-risk relatives and, as such, molecular genetic testing is now considered an integral component of the clinical care pathway. However, ICAs are characterised by high genetic and allelic heterogeneity, incomplete / age-related penetrance, and variable expressivity. Therefore, despite our improved understanding of the genetic basis of these conditions, and significant technological advances over the past two decades, identifying and recognising the causative genotype remains challenging. As clinical genetic testing for ICAs becomes more widely available, it is increasingly important for clinical laboratories to consolidate existing knowledge and experience to inform and improve future practice. These recommendations have been compiled to help clinical laboratories navigate the challenges of ICAs and thereby facilitate best practice and consistency in genetic test provision for this group of disorders. General recommendations on internal and external quality control, referral, analysis, result interpretation, and reporting are described. Also included are appendices that provide specific information pertinent to genetic testing for hypertrophic, dilated, and arrhythmogenic right ventricular cardiomyopathies, long QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia.</p

Global population structure and genotyping framework for genomic surveillance of the major dysentery pathogen, Shigella sonnei.

Shigella sonnei is the most common agent of shigellosis in high-income countries, and causes a significant disease burden in low- and middle-income countries. Antimicrobial resistance is increasingly common in all settings. Whole genome sequencing (WGS) is increasingly utilised for S. sonnei outbreak investigation and surveillance, but comparison of data between studies and labs is challenging. Here, we present a genomic framework and genotyping scheme for S. sonnei to efficiently identify genotype and resistance determinants from WGS data. The scheme is implemented in the software package Mykrobe and tested on thousands of genomes. Applying this approach to analyse >4,000 S. sonnei isolates sequenced in public health labs in three countries identified several common genotypes associated with increased rates of ciprofloxacin resistance and azithromycin resistance, confirming intercontinental spread of highly-resistant S. sonnei clones and demonstrating the genomic framework can facilitate monitoring the spread of resistant clones, including those that have recently emerged, at local and global scales

The HeMoVal study protocol: a prospective international multicenter cohort study to validate cerebrospinal fluid hemoglobin as a monitoring biomarker for aneurysmal subarachnoid hemorrhage related secondary brain injury.

INTRODUCTION Preclinical studies provided a strong rationale for a pathophysiological link between cell-free hemoglobin in the cerebrospinal fluid (CSF-Hb) and secondary brain injury after subarachnoid hemorrhage (SAH-SBI). In a single-center prospective observational clinical study, external ventricular drain (EVD) based CSF-Hb proved to be a promising biomarker to monitor for SAH-SBI. The primary objective of the HeMoVal study is to prospectively validate the association between EVD based CSF-Hb and SAH-SBI during the first 14 days post-SAH. Secondary objectives include the assessment of the discrimination ability of EVD based CSF-Hb for SAH-SBI and the definition of a clinically relevant range of EVD based CSF-Hb toxicity. In addition, lumbar drain (LD) based CSF-Hb will be assessed for its association with and discrimination ability for SAH-SBI. METHODS HeMoVal is a prospective international multicenter observational cohort study. Adult patients admitted with aneurysmal subarachnoid hemorrhage (aSAH) are eligible. While all patients with aSAH are included, we target a sample size of 250 patients with EVD within the first 14 day after aSAH. Epidemiologic and disease-specific baseline measures are assessed at the time of study inclusion. In patients with EVD or LD, each day during the first 14 days post-SAH, 2 ml of CSF will be sampled in the morning, followed by assessment of the patients for SAH-SBI, co-interventions, and complications in the afternoon. After 3 months, a clinical follow-up will be performed. For statistical analysis, the cohort will be stratified into an EVD, LD and full cohort. The primary analysis will quantify the strength of association between EVD based CSF-Hb and SAH-SBI in the EVD cohort based on a generalized additive model. Secondary analyses include the strength of association between LD based CSF-Hb and SAH-SBI in the LD cohort based on a generalized additive model, as well as the discrimination ability of CSF-Hb for SAH-SBI based on receiver operating characteristic (ROC) analyses. DISCUSSION We hypothesize that this study will validate the value of CSF-Hb as a biomarker to monitor for SAH-SBI. In addition, the results of this study will provide the potential base to define an intervention threshold for future studies targeting CSF-Hb toxicity after aSAH. STUDY REGISTRATION ClinicalTrials.gov Identifier NCT04998370 . Date of registration: August 10, 2021

Advancing One Health: Updated core competencies

One Health recognises the interdependence between the health of humans, animals, plants and the environment. With the increasing inclusion of One Health in multiple global health strategies, the One Health workforce must be prepared to protect and sustain the health and well-being of life on the planet. In this paper, a review of past and currently accepted One Health core competencies was conducted, with competence gaps identified. Here, the Network for Ecohealth and One Health (NEOH)propose updated core competencies designed to simplify what can be a complex area, grouping competencies into three main areas of: Skills; Values and Attitudes; and Knowledge and Awareness; with several layers underlying each. These are intentionally applicable to stakeholders from various sectors and across all levels to support capacity-building efforts within the One Health workforce. The updated competencies from NEOH can be used to evaluate and enhance current curricula, create new ones, or inform professional training programs at all levels, including students, university teaching staff, or government officials as well as continual professional development for frontline health practitioners and policy makers. The competencies are aligned with the new definition of One Health developed by the One Health High-Level Expert Panel (OHHLEP), and when supported by subject-specific expertise, will deliver the transformation needed to prevent and respond to complex global challenges. One Health Impact Statement Within a rapidly changing global environment, the need for practitioners competent in integrated approaches to health has increased substantially. Narrow approaches may not only limit opportunities for global and local solutions but, initiatives that do not consider other disciplines or social, economic and cultural contexts, may result in unforeseen and detrimental consequences. In keeping with principles of One Health, the Network for Ecohealth and One Health (NEOH) competencies entail a collaborative effort between multiple disciplines and sectors. They focus on enabling practitioners, from any background, at any level or scale of involvement, to promote and support a transformation to integrated health approaches. The updated competencies can be layered with existing disciplinary competencies and used to evaluate and enhance current education curricula, create new ones, or inform professional training programs at all levels -including for students, teachers and government officials as well as continual professional development for frontline health practitioners and policymakers. The competencies outlined here are applicable to all professionals and disciplines who may contribute to One Health, and are complimentary to, not a replacement for, any discipline-specific competencies. We believe the NEOH competencies meet the need outlined by the Quadripartite’s (Food and Agriculture Organisation, United Nations Environment Programme, World Health Organisation, World Organisation for Animal Health) Joint Plan of Action on One Health which calls for cross-sectoral competencies