The Massachusetts Commonwealth Health Insurance Connector: Structure and Functions

Describes the role and financing of the Commonwealth Health Insurance Connector Authority, an agency created to help small businesses and individuals buy affordable, high-quality insurance. Considers its potential as a model for national reform

The transformation of community hospitals through the transition to value-based care: Lessons from Massachusetts

Enabling community hospitals to provide efficient and effective care and maintain competition on par with their academic medical center (AMC) counterparts remain challenges for most states. Advancing accountable care readiness adds to the complexity of these challenges. Community hospitals experience narrower operating margins and more limited access to large populations than their AMC counterparts, making the shift to value-based care difficult. Massachusetts has taken legislative action to ensure a statewide focus on reducing healthcare costs, which includes a nearly $120-million grant program supporting community hospital and system transformation toward a value-based environment. The Massachusetts Health Policy Commission’s Community Hospital Acceleration, Revitalization and Transformation (CHART) investment program is the state’s largest effort to date aimed at readying community hospitals for value-based care. In doing so, Massachusetts has created the largest state-driven, all-payer (payer-blind) readmission reduction initiative in the country. n this paper, we examine the design and evolution of CHART Phases 1 and 2 and offer insights for other states contemplating innovative approaches to bolstering community hospital participation in value-based care models

Community Conversation Guide: How Can Our Community Support the Breastfeeding Experience in Brookings Businesses

This forum is an opportunity for our community to come together and consider breastfeeding and support for our mothers and children with fresh eyes, fresh ideas, and a fresh conversation. Our conversation today will consider different approaches for increasing breastfeeding support in local businesses. This guide introduces the issue, explains concerns with the breastfeeding experience in Brookings businesses, and presents three approaches to improving support. These approaches are not the only possible responses to the issue. Instead, they represent different ways that our community can take action based on our priorities

Brookings Supports Breastfeeding: Using Public Deliberation as a Community-Engaged Approach to Dissemination of Research

Empirical evidence demonstrates myriad benefits of breastfeeding for mother and child, along with benefits to businesses that support breastfeeding. Federal and state legislation requires workplace support for pumping and provides protections for public breastfeeding. Yet, many are unaware of these laws, and thus, support systems remain underdeveloped. We used a community-based approach to spread awareness about the evidence-based benefits of breastfeeding and breastfeeding support. We worked to improve breastfeeding support at the local hospital, among local employers, and throughout the broader community. Our coalition representing the hospital, the chamber of commerce, the university, and local lactation consultants used a public deliberation model for dissemination. We held focus groups, hosted a public conversation, spoke to local organizations, and promoted these efforts through local media. The hospital achieved Baby-Friendly status and opened a Baby Café. Breastfeeding support in the community improved through policies, designated pumping spaces, and signage that supports public breastfeeding at local businesses. Community awareness of the benefits of breastfeeding and breastfeeding support increased; the breastfeeding support coalition remains active. The public deliberation process for dissemination engaged the community with evidence-based promotion of breastfeeding support, increased agency, and produced sustainable results tailored to the community’s unique needs

Caregiver Behavior Change for Child Survival and Development in Low- and Middle-Income Countries: An Examination of the Evidence

In June of 2012, representatives from more than 80 countries promulgated a Child Survival Call to Action, which called for reducing child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035. To address the problem of ending preventable child deaths, the U.S. Agency for International Development and the United Nations Children’s Fund convened, on June 3–4, 2013, an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change. Six evidence review teams were established on different topics related to child survival and healthy development to identify the relevant evidence-based interventions and to prepare reports. This article was developed by the evidence review team responsible for identifying the research literature on caregiver change for child survival and development. This article is organized into childhood developmental periods and cross-cutting issues that affect child survival and healthy early development across all these periods. On the basis of this review, the authors present evidence-based recommendations for programs focused on caregivers to increase child survival and promote healthy development. Last, promising directions for future research to change caregivers’ behaviors are given

Fragile Genomic Sites Are Associated with Origins of Replication

Genome rearrangements are mediators of evolution and disease. Such rearrangements are frequently bounded by transfer RNAs (tRNAs), transposable elements, and other repeated elements, suggesting a functional role for these elements in creating or repairing breakpoints. Though not well explored, there is evidence that origins of replication also colocalize with breakpoints. To investigate a potential correlation between breakpoints and origins, we analyzed evolutionary breakpoints defined between Saccharomyces cerevisiae and Kluyveromyces waltii and S. cerevisiae and a hypothetical ancestor of both yeasts, as well as breakpoints reported in the experimental literature. We find that origins correlate strongly with both evolutionary breakpoints and those described in the literature. Specifically, we find that origins firing earlier in S phase are more strongly correlated with breakpoints than are later-firing origins. Despite origins being located in genomic regions also bearing tRNAs and Ty elements, the correlation we observe between origins and breakpoints appears to be independent of these genomic features. This study lays the groundwork for understanding the mechanisms by which origins of replication may impact genome architecture and disease

Caregiver Behavior Change for Child Survival and Development in Low- and Middle-Income Countries: An Examination of the Evidence

In June of 2012, representatives from more than 80 countries promulgated a Child Survival Call to Action, which called for reducing child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035. To address the problem of ending preventable child deaths, the U.S. Agency for International Development and the United Nations Children’s Fund convened, on June 3–4, 2013, an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change. Six evidence review teams were established on different topics related to child survival and healthy development to identify the relevant evidence-based interventions and to prepare reports. This article was developed by the evidence review team responsible for identifying the research literature on caregiver change for child survival and development. This article is organized into childhood developmental periods and cross-cutting issues that affect child survival and healthy early development across all these periods. On the basis of this review, the authors present evidence-based recommendations for programs focused on caregivers to increase child survival and promote healthy development. Last, promising directions for future research to change caregivers’ behaviors are given

COVID19 Disease Map, a computational knowledge repository of virus-host interaction mechanisms.

Funder: Bundesministerium für Bildung und ForschungFunder: Bundesministerium für Bildung und Forschung (BMBF)We need to effectively combine the knowledge from surging literature with complex datasets to propose mechanistic models of SARS-CoV-2 infection, improving data interpretation and predicting key targets of intervention. Here, we describe a large-scale community effort to build an open access, interoperable and computable repository of COVID-19 molecular mechanisms. The COVID-19 Disease Map (C19DMap) is a graphical, interactive representation of disease-relevant molecular mechanisms linking many knowledge sources. Notably, it is a computational resource for graph-based analyses and disease modelling. To this end, we established a framework of tools, platforms and guidelines necessary for a multifaceted community of biocurators, domain experts, bioinformaticians and computational biologists. The diagrams of the C19DMap, curated from the literature, are integrated with relevant interaction and text mining databases. We demonstrate the application of network analysis and modelling approaches by concrete examples to highlight new testable hypotheses. This framework helps to find signatures of SARS-CoV-2 predisposition, treatment response or prioritisation of drug candidates. Such an approach may help deal with new waves of COVID-19 or similar pandemics in the long-term perspective

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Brain multiplexes reveal morphological connectional biomarkers fingerprinting late brain dementia states

Accurate diagnosis of mild cognitive impairment (MCI) before conversion to Alzheimer’s disease (AD) is invaluable for patient treatment. Many works showed that MCI and AD affect functional and structural connections between brain regions as well as the shape of cortical regions. However, ‘shape connections’ between brain regions are rarely investigated -e.g., how morphological attributes such as cortical thickness and sulcal depth of a specific brain region change in relation to morphological attributes in other regions. To fill this gap, we unprecedentedly design morphological brain multiplexes for late MCI/AD classification. Specifically, we use structural T1-w MRI to define morphological brain networks, each quantifying similarity in morphology between different cortical regions for a specific cortical attribute. Then, we define a brain multiplex where each intra-layer represents the morphological connectivity network of a specific cortical attribute, and each inter-layer encodes the similarity between two consecutive intra-layers. A significant performance gain is achieved when using the multiplex architecture in comparison to other conventional network analysis architectures. We also leverage this architecture to discover morphological connectional biomarkers fingerprinting the difference between late MCI and AD stages, which included the right entorhinal cortex and right caudal middle frontal gyrus