Integrated Health and Social Care in the United States: A Decade of Policy Progress.

INTRODUCTION: Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. POLICY PRACTICE: This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice. DISCUSSION AND CONCLUSION: National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors.

Multifunctional mesoporous curcumin encapsulated iron-phenanthroline nanocluster: A new Anti-HIV agent.

A new strategy to encapsulating the drug curcumin into the hydrophobic core of the iron-phenanthroline nanocomplex (NIP) and eventually its release is signified. NIP was prepared via coordinate interaction between Fe2+ and the lone pairs present on the N atoms of the bidentate phenanthroline ligand (spherical morphology, diameter 18.8 nm, mesoporous with pore size 2.443 nm, amorphous). Thereafter, curcumin was successfully encapsulated (NCIP) in NIP, resulting in its enhanced stability (spherical morphology, diameter 46.8 nm). The nanocomplex NIP was used for drug delivery applications. We evaluated the anti-HIV effects of NCIP in vitro on cultures of HIV infected human microglia. The treatment of HIV-1 infected microglia with NCIP significantly decreased the expression of HIV-p24 by 41% and pro-inflammatory mediators TNF-α, IL-8 and NO by 61.2%, 41% and 50.2%, respectively, compared to NIP. Flow cytometry data also support the decrease in TNF-α and IL-8 expression in case of NCIP. NCIP induced antioxidative effects by increasing the gene expression of catalase (CAT) and simulatenously decreasing hemeoxygenase-1 (HMOX-1) gene expression, thereby maintaining homeostasis which reduces neuroinflammation. These results support our premise that NCIP may be a significant adjuvant when used with traditional anti-retroviral regimens and may ameliorate HIV-1 associated neurotoxicity.

Prediction of miRNA and Identification of their Relationship Network Related to Late Blight Disease of Potato.

BACKGROUND: Late blight is a serious disease in potato caused by Phytophthora infestans. To date only few miRNA have been discovered which are related to late blight disease of potato during host pathogen interaction. Recent studies showed that miRNA, an important gene expression regulator, plays a very important role in host-pathogen interaction by silencing genes either by destructing or blocking of translation of mRNA. METHOD: Homology search was performed between non-redundant mature miRNA sequences from miRBase database and Solanum tuberosum EST sequences from NCBI database. Screening of the potential miRNA was done after secondary structure prediction. The target related to late blight disease of respective miRNA was functionally annotated. To identify the relationship between the predicted and mature miRNAs, multiple sequence alignment and evolutionary relationships were established. RESULTS AND CONCLUSION: 34 Candidate miRNA related to late blight disease of potato were identified which were associated to five target genes. These miRNAs were linked with Avr3a, INF1, INF2b genes which are elicitin like protein and triggers a hypersensitive response to host cell. Mapping of target sequences showed similarity with Solanum lycopersicum NRC1 gene of chr.1, which are reported as a casual protein required for Pto-mediated cell death and resistance in N. benthamiana. NRC1 are considered as a RX-CC_like domain-containing protein which shows similarity with coiledcoil domain of the potato virus X resistance protein (RX) in Solanum tuberosum. RX recognizes pathogen effector proteins and triggers a response that may be as severe as localized cell death thereby providing resistance against potato virus X.

Visual Cross-Modal Re-Organization in Children with Cochlear Implants.

BACKGROUND: Visual cross-modal re-organization is a neurophysiological process that occurs in deafness. The intact sensory modality of vision recruits cortical areas from the deprived sensory modality of audition. Such compensatory plasticity is documented in deaf adults and animals, and is related to deficits in speech perception performance in cochlear-implanted adults. However, it is unclear whether visual cross-modal re-organization takes place in cochlear-implanted children and whether it may be a source of variability contributing to speech and language outcomes. Thus, the aim of this study was to determine if visual cross-modal re-organization occurs in cochlear-implanted children, and whether it is related to deficits in speech perception performance. METHODS: Visual evoked potentials (VEPs) were recorded via high-density EEG in 41 normal hearing children and 14 cochlear-implanted children, aged 5-15 years, in response to apparent motion and form change. Comparisons of VEP amplitude and latency, as well as source localization results, were conducted between the groups in order to view evidence of visual cross-modal re-organization. Finally, speech perception in background noise performance was correlated to the visual response in the implanted children. RESULTS: Distinct VEP morphological patterns were observed in both the normal hearing and cochlear-implanted children. However, the cochlear-implanted children demonstrated larger VEP amplitudes and earlier latency, concurrent with activation of right temporal cortex including auditory regions, suggestive of visual cross-modal re-organization. The VEP N1 latency was negatively related to speech perception in background noise for children with cochlear implants. CONCLUSION: Our results are among the first to describe cross modal re-organization of auditory cortex by the visual modality in deaf children fitted with cochlear implants. Our findings suggest that, as a group, children with cochlear implants show evidence of visual cross-modal recruitment, which may be a contributing source of variability in speech perception outcomes with their implant.

Cortical development and neuroplasticity in Auditory Neuropathy Spectrum Disorder.

Cortical development is dependent to a large extent on stimulus-driven input. Auditory Neuropathy Spectrum Disorder (ANSD) is a recently described form of hearing impairment where neural dys-synchrony is the predominant characteristic. Children with ANSD provide a unique platform to examine the effects of asynchronous and degraded afferent stimulation on cortical auditory neuroplasticity and behavioral processing of sound. In this review, we describe patterns of auditory cortical maturation in children with ANSD. The disruption of cortical maturation that leads to these various patterns includes high levels of intra-individual cortical variability and deficits in cortical phase synchronization of oscillatory neural responses. These neurodevelopmental changes, which are constrained by sensitive periods for central auditory maturation, are correlated with behavioral outcomes for children with ANSD. Overall, we hypothesize that patterns of cortical development in children with ANSD appear to be markers of the severity of the underlying neural dys-synchrony, providing prognostic indicators of success of clinical intervention with amplification and/or electrical stimulation. This article is part of a Special Issue entitled .

Cross-modal re-organization in adults with early stage hearing loss.

Cortical cross-modal re-organization, or recruitment of auditory cortical areas for visual processing, has been well-documented in deafness. However, the degree of sensory deprivation necessary to induce such cortical plasticity remains unclear. We recorded visual evoked potentials (VEP) using high-density electroencephalography in nine persons with adult-onset mild-moderate hearing loss and eight normal hearing control subjects. Behavioral auditory performance was quantified using a clinical measure of speech perception-in-noise. Relative to normal hearing controls, adults with hearing loss showed significantly larger P1, N1, and P2 VEP amplitudes, decreased N1 latency, and a novel positive component (P2') following the P2 VEP. Current source density reconstruction of VEPs revealed a shift toward ventral stream processing including activation of auditory temporal cortex in hearing-impaired adults. The hearing loss group showed worse than normal speech perception performance in noise, which was strongly correlated with a decrease in the N1 VEP latency. Overall, our findings provide the first evidence that visual cross-modal re-organization not only begins in the early stages of hearing impairment, but may also be an important factor in determining behavioral outcomes for listeners with hearing loss, a finding which demands further investigation.

Antifungal potential of triphala churna ingredients against Aspergillus species associated with them during storage.

The present study describes the antifungal potential of fruit and powdered ingredients of triphala churna, i.e. Emblica officinalis (Garetn.) (Amla), Terminalia bellirica (Gaertn.) Roxb. (Baheda) and Terminalia chebula (Retz.) (Harada), collected from the market of Gwalior (M.P.), India. Water extracts of all the fruits and powdered samples were tested (in vitro) for their antifungal activities by poisoned food technique against different Aspergillus species (A. flavus, A. fumigatus, A. versicolor, A. terreus and A. niger) associated with them during storage. All extracts displayed varied levels i.e. very low to very high antifungal activities on four Aspergillus species. The aqueous extracts of fresh fruits (37.96 +/- 7.59%) was observed to be most effective than dry fruits (34.95 +/- 7.59%) and powder (25.07 +/- 6.05%). Terminalia chebula (fresh and dry) extracts were found most active against the four Aspergillus species with 49.15 and 40.8% inhibition, respectively. None of the extracts were found effective against the growth of A. niger. All fruits and powdered aqueous extracts were observed to be ineffective against the A. niger. The variability in antifungal activity of aqueous extracts in the present study may be useful to study the relationship between antifungal potential of herbal drugs and prevalence of fungal contaminant during their storage.

Lipotab, a polyherbal formulation, attenuates isoprenaline-induced left ventricular remodeling and heart failure in rats.

The present study was designed to evaluate the effect of Lipotab, a polyherbal formulation on isoprenaline (ISO)-induced left ventricular (LV) remodeling and heart failure (HF). HF in Wistar albino rats was produced by two consecutive injections of ISO (150 mg/kg, s.c.) at an interval of 24 h. After 15 days of 2nd ISO injection, HF was indicated by rise in left ventricular end-diastolic pressure (LVEDP), lowering of maximal rate of rise of LV pressure divided by LV systolic pressure (LVdP/dtmax/P; cardiac contractility) and maximal rate of fall of LV pressure (LVdP/dtmin), fall in cardiac output (CO), cardiac hypertrophy (heart to body weight ratio) and histopathological changes in heart. HF rats showed a significant increase in serum malondialdehyde (MDA), reduction in serum reduced glutathione (GSH) content and a significant rise in tumor necrosis factor-α (TNF-α) level. Prior treatment with Lipotab (275 mg/kg/day, p.o.) was significantly able to preserve LV functions. Post treatment with Lipotab (275 mg/kg/day, p.o.) also improved LV functions but did not prevent the fall in LVdP/ dtmin, CO and cardiac hypertrophy. Lipotab significantly prevented fall in GSH levels, rise in level of MDA and TNF-α in serum of HF rats. Histopathological examination confirmed hemodynamic and biochemical findings. Results of the present study indicate that Lipotab prevents ISO-induced LV remodeling and consequent HF in rats through its antioxidant and anti-inflammatory activity.

Abnormalities in central auditory maturation in children with language-based learning problems.

OBJECTIVE: To examine maturation of the central auditory pathways in children with language-based learning problems (LP). METHODS: Cortical auditory evoked potentials (CAEPs) recorded from 26 children with LP were compared to CAEPs recorded from 38 typical children. CAEP responses were recorded in response to a speech sound, /uh/, which was presented in a stimulus train with decreasing inter-stimulus intervals (ISIs) of 2000, 1000, 560, and 360 ms. RESULTS: We identified three atypical morphological categories of CAEP responses in the LP group. Category 1 responses revealed delayed P1 latencies and absent N1/P2 components. Category 2 responses revealed typical P1 responses, but delayed N1 and P2 responses. Category 3 responses revealed generally low-amplitude CAEP responses. A fourth sub-group of LP children had normal CAEP responses. CONCLUSIONS: Overall, the majority of children with LP had abnormal CAEP responses. These children fell into distinct categories based on the abnormalities in maturational patterns of their CAEP responses. SIGNIFICANCE: We describe a rate sensitive stimulation paradigm which may be used to identify and categorize LP children who exhibit abnormal patterns of central auditory maturation.

The influence of a sensitive period on central auditory development in children with unilateral and bilateral cochlear implants.

We examined the longitudinal development of the cortical auditory evoked potential (CAEP) in 21 children who were fitted with unilateral cochlear implants and in two children who were fitted with bilateral cochlear implants either before age 3.5 years or after age 7 years. The age cut-offs (<3.5 years for early-implanted and >7 years for late-implanted) were based on the sensitive period for central auditory development described in [Ear Hear. 23 (6), 532.] Our results showed a fundamentally different pattern of development of CAEP morphology and P1 cortical response latency for early- and late-implanted children. Early-implanted children and one child who received bilateral implants by age 3.5 years showed rapid development in CAEP waveform morphology and P1 latency. Late-implanted children showed aberrant waveform morphology and significantly slower decreases in P1 latency postimplantation. In the case of a child who received his first implant by age 3.5 years and his second implant after age 7 years, CAEP responses elicited by the second implant were similar to late-implanted children. Our results are consistent with animal models of central auditory development after implantation and confirm the presence of a relatively brief sensitive period for central auditory development in young children.

Developmental changes in refractoriness of the cortical auditory evoked potential.

OBJECTIVE: This study examined morphological changes in the cortical auditory evoked potential (CAEP) waveform as a function of varying stimulation rate. Stimuli were presented in a paradigm which indirectly assesses the refractory properties of the underlying neuronal generators. METHODS: CAEPs were recorded in 50 normal-hearing children (3-12 years) and 10 young adults (24-26 years). A speech sound was presented in a stimulus train with sequentially decreasing inter-stimulus intervals (ISIs) of 2000, 1000, 560, and 360ms. Latencies and amplitudes of the P1, N1, and P2 components at the Cz electrode were examined as a function of stimulus rate and age. RESULTS: Results revealed significant changes in the CAEP as a function of age and stimulation rate. At younger ages the N1-P2 component was elicited only at the slowest stimulation rates, and was more clearly apparent at successively faster stimulation rates as age increased. CONCLUSIONS: We have described a stimulus paradigm that allows examination of the development of refractoriness by highlighting the interaction between age and rate on CAEP morphology. SIGNIFICANCE: Complex maturational patterns of CAEP components are best understood when the effects of both age and stimulus rate on the CAEP waveform are considered.

Benign mechanical transport of breast epithelial cells to sentinel lymph nodes.

The evaluation of sentinel lymph nodes (SLNs) for the presence of malignant epithelial cells is essential to the staging of breast cancer patients. Recently, increased attention has focused on the possibility that epithelial cells may reach SLNs by benign mechanical means, rather than by metastasis. The purpose of this study was to test the hypothesis that pre-SLN biopsy breast massage, which we currently use to facilitate the localization of SLNs, might represent a mode of benign mechanical transport. We studied 56 patients with invasive and/or in situ ductal carcinoma and axillary SLNs with only epithelial cells and/or cell clusters (< or =0.2 mm in diameter and not associated with features of established metastases) detected predominantly in subcapsular sinuses of SLNs on hematoxylin and eosin- and/or anti-cytokeratin-stained sections. No patient had an SLN involved by either micro- or macro-metastatic carcinoma. Epithelial cells and cell clusters, < or =0.2 mm in size and without features of established metastases, occurred more frequently in the SLNs of patients who underwent pre-SLN biopsy breast massage (P < 0.001, chi2 test). The latter finding supports the hypothesis that pre-SLN biopsy breast massage is a mode of benign mechanical transport of epithelial cells to SLNs.