Simplification of Health and Social Services Enrollment and Eligibility: Lessons for California From Interviews in Four States

Explores state officials' and advocates' views on issues involved in streamlining enrollment and eligibility processes, including the importance of staff buy-in, community partners' outreach efforts, and technological challenges and lessons learned

Hidrolizados proteicos con actividad antioxidante a partir de la hidrólisis enzimática de la Chenopodium pallidicaule Aellen “Cañihua"

Publicación a texto completo no autorizada por el autorEvalúa la actividad antioxidante del hidrolizado proteico de la harina desengrasada de las semillas de Chenopodium pallidicaule Aellen (cañihua). Se obtuvo proteínas que fueron concentrados por precipitación isoeléctrica y sometido a hidrólisis por dos enzimas proteolíticas con actividad endopeptidasas y exopeptidasas: Proteasa Bacillus lichniformis (PBL) y Proteasa Aspergillus oryzae (PAO), respectivamente. Se cuantificó la liberación de péptidos a los 90 min de hidrólisis de forma independiente y adicionalmente 150 min para enzimas de forma secuencial, la relación enzima/sutrato de 10% (v/v) y Temperatura a 50 °C para ambos casos. Las enzimas de forma independiente de PAO y PBL incrementaron la liberación de péptidos hasta 241.24 y 269.32 µmol tirosina/mL respectivamente en comparación al concentrado de proteínas sin hidrolizar. Para la adición de enzimas de manera secuencial PAO + PBL y PBL + PAO incrementaron la liberación de péptidos hasta 399.92 y 315.80 µmol tirosina/mL respectivamente. La actividad antioxidante de los hidrolizados fue evaluada por el método del radical 1,1-difenil-2-picrilhidrazil (DPPH). Esta actividad se expresó en IC50; para las muestras con mayor cantidad de péptido de PBL, PAO, PBL + PAO y PAO + PBL fueron 11.608, 10.924, 7.232, 9.168 ug/mL respectivamente y para el TROLOX fue 5.007 ug/mL. Con estos resultados se observó que los hidrolizados presentaron una buena actividad antioxidante; por lo tanto, constituyen una buena fuente para la obtención de péptidos bioactivos.Tesi

Métodos proyectuales para un terminal terrestre Interprovincial en el borde distrital de Tarapoto y la Banda de Shilcayo

En la actualidad, una de las problemáticas más significativas que presenta la provincia de San Martín y específicamente los tres núcleos más representativos de la provincia, es la ausencia de una infraestructura que albergue a todas las empresas de transporte, que actualmente se emplaza únicamente en una sola urbe (Morales), por consiguiente, de esta manera articular los distritos de Tarapoto y la Banda de Shilcayo a través de una propuesta vial, disminuyendo así la congestión vehicular en la intersección de ambos cascos urbanos.. La presente investigación plantea desarrollar estrategias de emplazamiento, territoriales y de espacios de socialización e interacción, para generar una articulación vial, descongestionamiento vehicular y un mejor emplazamiento del lugar. Por otro lado, determinar e identificar la relación existente y las problemáticas presentadas en el límite distrital de ambas urbes antes mencionada (Tarapoto y la Banda de Shilcayo) y lo que se plantea potenciar dentro del territorio, por medio de las tácticas que se componen a base de la elaboración de diferentes mapeos del sistema vial, registro fotográfico y entrevistas aplicadas a entidades y a la ciudadanía en general. Por consiguiente, los aspectos del estudio se desarrollan de la siguiente manera, se inicia con el enfoque a la caracterización de la movilidad urbana como articulador del transporte interprovincial, continuando con la dinámica territorial y sistema vial urbano en el borde del distrito de Tarapoto y la Banda de Shilcayo y finalmente se estudia la articulación vial y emplazamiento territorial para un terminal terrestre interprovincial. Para concluir, la investigación tiene como enfoque el desarrollo de Métodos proyectuales para un terminal terrestre Interprovincial en el borde distrital de Tarapoto y la Banda de Shilcayo.TARAPOTOEscuela Profesional de ArquitecturaProyecto Arquitectónico y Paisaj

Identificação e análise da cadeia de comercialização de pescado em Marataízes, ES: Um estudo de caso / Identification and analysis of the fish marketing chain in Marataízes, ES: A case study

A atividade pesqueira em Marataízes é muito ativa e apresenta uma rede organizada de agentes que participam da comercialização do pescado, entretanto esta rede organizada carece de estudos que descrevem sua atuação e impactos no município. Este estudo teve por objetivo identificar e analisar os principais compradores de pescado que atuam na comunidade de Pontal em Marataízes-ES. Através da aplicação de um questionário estruturado submetido aos responsáveis pelas pescarias foi possível identificar três segmentos distintos e relacioná-los aos recursos desembarcados na comunidade: peixarias que comercializam o pargo, peroá e dourado; as empresas com foco em recursos pelágicos; e atravessador, com atuação significativa no recurso pargo, lagosta e peroá. Constatando que apesar da pesca ser uma atividade com significativa importância social e econômica para o município de Marataízes, ela carece de estruturas de apoio para recebimento e manipulação do pescado

An original phylogenetic approach identified mitochondrial haplogroup T1a1 as inversely associated with breast cancer risk in BRCA2 mutation carriers

Introduction: Individuals carrying pathogenic mutations in the BRCA1 and BRCA2 genes have a high lifetime risk of breast cancer. BRCA1 and BRCA2 are involved in DNA double-strand break repair, DNA alterations that can be caused by exposure to reactive oxygen species, a main source of which are mitochondria. Mitochondrial genome variations affect electron transport chain efficiency and reactive oxygen species production. Individuals with different mitochondrial haplogroups differ in their metabolism and sensitivity to oxidative stress. Variability in mitochondrial genetic background can alter reactive oxygen species production, leading to cancer risk. In the present study, we tested the hypothesis that mitochondrial haplogroups modify breast cancer risk in BRCA1/2 mutation carriers. Methods: We genotyped 22,214 (11,421 affected, 10,793 unaffected) mutation carriers belonging to the Consortium of Investigators of Modifiers of BRCA1/2 for 129 mitochondrial polymorphisms using the iCOGS array. Haplogroup inference and association detection were performed using a phylogenetic approach. ALTree was applied to explore the reference mitochondrial evolutionary tree and detect subclades enriched in affected or unaffected individuals. Results: We discovered that subclade T1a1 was depleted in affected BRCA2 mutation carriers compared with the rest of clade T (hazard ratio (HR) = 0.55; 95% confidence interval (CI), 0.34 to 0.88; P = 0.01). Compared with the most frequent haplogroup in the general population (that is, H and T clades), the T1a1 haplogroup has a HR of 0.62 (95% CI, 0.40 to 0.95; P = 0.03). We also identified three potential susceptibility loci, including G13708A/rs28359178, which has demonstrated an inverse association with familial breast cancer risk. Conclusions: This study illustrates how original approaches such as the phylogeny-based method we used can empower classical molecular epidemiological studies aimed at identifying association or risk modification effects.Peer reviewe

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations