The Living Alone with Cognitive Impairment Project's Policy Advisory Group on Long-Term Services and Supports: Setting a Research Equity Agenda.

(1) Background: A United States national policy advisory group (PAG) was convened to identify barriers and facilitators to expand formal long-term services and support (LTSS) for people living alone with cognitive impairment (PLACI), with a focus on equitable access among diverse older adults. The PAG's insights will inform the research activities of the Living Alone with Cognitive Impairment Project, which is aimed at ensuring the equitable treatment of PLACI. (2) Methods: The PAG identified barriers and facilitators of providing effective and culturally relevant LTSS to PLACI via one-on-one meetings with researchers, followed by professionally facilitated discussions among themselves.

Identifying and Understanding Transfusion Reactions in the Oncology Population.

Objectives: To provide an overview of transfusion reactions, their underlying pathophysiology, clinical presentation, and recommendations for nursing management.

Data Sources: We researched peer-reviewed journal articles, book chapters, Internet, and lecture proceedings.

Conclusion: Transfusion reactions are adverse reactions to blood products frequently seen in the oncology population and can significantly vary in severity and etiology.

Emerging Approaches for Fluorescence-Based Newborn Screening of Mucopolysaccharidoses.

Interest in newborn screening for mucopolysaccharidoses (MPS) is growing, due in part to ongoing efforts to develop new therapies for these disorders and new screening assays to identify increased risk for the individual MPSs on the basis of deficiency in the cognate enzyme. Existing tests for MPSs utilize either fluorescence or mass spectrometry detection methods to measure biomarkers of disease (e.g.

Fluorimetric assay with a novel substrate for quantification of galactocerebrosidase activity in dried blood spot specimens.

Background: Decreased galactocerebrosidase (GALC) enzyme activity is causative for Krabbe disease, a lysosomal storage disorder with devastating neurodegenerative consequences. Quantitative fluorimetric assays for GALC activity in isolated blood and skin cells have been described; however, no such assay has been described using dried blood spot (DBS) specimens.

Methods: GALC enzyme activity was measured quantitatively using fluorescence from a novel glycosidic substrate: carboxy derived from 6-hexadecanoylamino-4-methylumbelliferone.

Antifungal Activity of the Enterococcus faecalis Peptide EntV Requires Protease Cleavage and Disulfide Bond Formation.

, a Gram-positive bacterium, and , a polymorphic fungus, are common constituents of the microbiome as well as increasingly problematic causes of infections. Interestingly, we previously showed that these two species antagonize each other's virulence and that inhibition of was specifically mediated by EntV. EntV is a bacteriocin encoded by the () locus that reduces virulence and biofilm formation by inhibiting hyphal morphogenesis.

Phase II Study of Systemic High-dose Methotrexate and Intrathecal Liposomal Cytarabine for Treatment of Leptomeningeal Carcinomatosis From Breast Cancer.

Metastatic breast cancer frequently leads to brain metastases and, less commonly, leptomeningeal carcinomatosis (LC). Once cerebrospinal fluid involvement occurs, the prognosis is poor. There are limited treatment options available, but none offer significant survival benefit.

Assessing the Quality of Nursing Homes in Managed Care Organizations: Integrating LTSS for Dually Eligible Beneficiaries.

Little is known about the quality of nursing homes in managed care organizations (MCOs) networks. This study (1) described decision-making criteria for selecting nursing home networks and (2) compared selected quality indicators of network and nonnetwork nursing homes. The sample was 17 MCOs participating in a California demonstration that provided integrated long-term services and supports to dually eligible enrollees in 2017.

Beneficiaries Respond To California's Program To Integrate Medicare, Medicaid, And Long-Term Services.

In 2014 California implemented a demonstration project called Cal MediConnect, which used managed care organizations to integrate Medicare and Medicaid, including long-term services and supports for beneficiaries dually eligible for Medicare and Medicaid. Postenrollment telephone surveys assessed how enrollees adjusted to Cal MediConnect over time. Results showed increased satisfaction with benefits, improved ratings of quality of care, fewer acute care visits, and increased personal care assistance hours over time.

Integration of Medicare and Medicaid for dually eligible beneficiaries: A focus group study examining beneficiaries' early experiences in California's dual financial alignment demonstration.

Background: In 2014 California implemented a federal dual alignment demonstration used a capitated managed healthcare model called Cal MediConnect (CMC) to integrate medical care and long term services and supports (LTSS) for beneficiaries with both Medicare and Medicaid. These beneficiaries often have complex care needs, including multiple chronic conditions and disabilities. By 2016, 120,000 eligible beneficiaries were enrolled in the program.

Impact of the Village Model: Results of a National Survey.

Villages are a relatively new, consumer-directed model that brings together older adults in a community who have a mutual interest in aging in place. These membership organizations provide social and civic engagement opportunities, volunteer provided support services, and referral to vetted community providers to achieve their primary goals of promoting independence and preventing undesired relocations. This cross sectional survey of 1,753 active Village members from 28 Villages across the US measured members' perceived impacts in the areas of social connection, civic engagement, service access, health and well-being, and ability to age in place.

bacteriocin EntV inhibits hyphal morphogenesis, biofilm formation, and virulence of .

, a Gram-positive bacterium, and , a fungus, occupy overlapping niches as ubiquitous constituents of the gastrointestinal and oral microbiome. Both species also are among the most important and problematic, opportunistic nosocomial pathogens. Surprisingly, these two species antagonize each other's virulence in both nematode infection and in vitro biofilm models.

Organizational Characteristics Associated With the Predicted Sustainability of Villages.

Guided by resource dependence theory, this mixed-methods study examined organizational characteristics contributing to the perceived sustainability of Villages, a rapidly proliferating grassroots approach for promoting social participation and service access for community-dwelling older adults. Surveys conducted with leaders of 86% of Villages in the United States in 2012 found that higher predicted confidence in their Village's 10-year survival was associated with greater financial reserves, human resources, number of Village members, formal policies and procedures, and formal collaboration agreements. Respondents' explanations of their confidence ratings revealed additional themes of organizational leadership and perceived community need.

Seniors' and People with Disabilities' Experiences with Mandatory Medicaid Managed Care in California: Populations to Target for Additional Support during Transitions.

With more states moving people with disabilities and complex care needs into managed care, it is important to target beneficiaries for additional anticipated support before specific needs arise. In a survey of 1,521 seniors and people with disabilities in California who moved into Medicaid managed care six-16 months previously, the majority reported neutral or positive experiences with managed care continuity, access, and quality, compared with fee-for-service. Beneficiaries most likely to have negative experiences included those with poor self-rated health, functional impairment, cognitive impairment, frequent ED visits, and claims for back / osteoarthritis and cancer.

Do Villages Promote Aging in Place? Results of a Longitudinal Study.

Villages are a new, grassroots, consumer-directed model that aims to promote aging in place and prevent unwanted relocations for older adults. In exchange for a yearly membership fee, Villages provide seniors with opportunities for social engagement (social events and classes), civic engagement (member-to-member volunteer opportunities), and an array of support services. In total, 222 Village members were surveyed at intake and 12-month follow-up to examine changes in their confidence aging in place, social connectedness, and health.

Primary central nervous system lymphoma treated with high-dose methotrexate and rituximab: A single-institution experience.

Rituximab (RTX) improves the outcome in patients with systemic diffuse large B-cell lymphoma (DLBCL), but its benefit in primary central nervous system lymphoma (PCNSL) is unclear. In the present study, a single-institution retrospective analysis was performed for 12 patients with newly diagnosed PCNSL treated with combined high-dose methotrexate (HD-MTX) and RTX. MTX was administered biweekly at 8 g/m/dose until a complete response (CR) was achieved or for a maximum of eight doses.

Medicaid beneficiaries in california reported less positive experiences when assigned to a managed care plan.

In 2011 California began transitioning approximately 340,000 seniors and people with disabilities from Medicaid fee-for-service (FFS) to Medicaid managed care plans. When beneficiaries did not actively choose a managed care plan, the state assigned them to one using an algorithm based on their previous FFS primary and specialty care use. When no clear link could be established, beneficiaries were assigned by default to a managed care plan based on weighted randomization.

An Integrated Model of Co-ordinated Community-Based Care.

Purpose Of The Study: Co-ordinated approaches to community-based care are a central component of current and proposed efforts to help vulnerable older adults obtain needed services and supports and reduce unnecessary use of health care resources.

Design And Methods: This study examines ElderHelp Concierge Club, an integrated community-based care model that includes comprehensive personal and environmental assessment, multilevel care co-ordination, a mix of professional and volunteer service providers, and a capitated, income-adjusted fee model. Evaluation includes a retrospective study (n = 96) of service use and perceived program impact, and a prospective study (n = 21) of changes in participant physical and social well-being and health services utilization.

The impact of the "Village" model on health, well-being, service access, and social engagement of older adults.

Background: Villages represent an emerging consumer-driven social support model that aims to enhance the social engagement, independence, and well-being of community-dwelling seniors through a combination of social activities, volunteer opportunities, service referral, and direct assistance. This study aimed to assess the perceived impact of Village membership on factors associated with the likelihood of aging in place. Additionally, the research examines the characteristics and service use of members who benefit the most.

Does the Village model help to foster age-friendly communities?

This article explores the potential role of the Village model, a social initiative that emphasizes member involvement and service access, in helping communities to become more age-friendly. A survey of 86.3% of operational Villages examined activities designed to help members access a variety of supports and services consistent with the World Health Organization's (WHO) Global Network of Age-Friendly Cities and Communities program model, as well as other potential contributions to community age friendliness.

Novel application of digital microfluidics for the detection of biotinidase deficiency in newborns.

Objective: Newborn screening for biotinidase deficiency can be performed using a fluorometric enzyme assay on dried blood spot specimens. As a pre-requisite to the consolidation of different enzymatic assays onto a single platform, we describe here a novel analytical method for detecting biotinidase deficiency using the same digital microfluidic cartridge that has already been demonstrated to screen for five lysosomal storage diseases (Pompe, Fabry, Gaucher, Hurler and Hunter) in a multiplex format.

Methods: A novel assay to quantify biotinidase concentration in dried blood spots (DBS) was developed and optimized on the digital microfluidic platform using proficiency testing samples from the Centers for Disease Control and Prevention.

Multiplex newborn screening for Pompe, Fabry, Hunter, Gaucher, and Hurler diseases using a digital microfluidic platform.

Purpose: New therapies for lysosomal storage diseases (LSDs) have generated interest in screening newborns for these conditions. We present performance validation data on a digital microfluidic platform that performs multiplex enzymatic assays for Pompe, Fabry, Hunter, Gaucher, and Hurler diseases.

Methods: We developed an investigational disposable digital microfluidic cartridge that uses a single dried blood spot (DBS) punch for performing a 5-plex fluorometric enzymatic assay on up to 44 DBS samples.

A tale of two community initiatives for promoting aging in place: similarities and differences in the national implementation of NORC programs and villages.

Purpose: Villages and Naturally Occurring Retirement Community (NORC) Supportive Service Programs (NORC programs) are among the most prominent community-based models for promoting aging in place. To advance systematic understanding of their development, this study examined how these models have been implemented nationally and the models' similarities and differences.

Design And Methods: A survey of program leaders representing 69 Villages and 62 NORC programs was conducted from January to June of 2012.

Rapid assays for Gaucher and Hurler diseases in dried blood spots using digital microfluidics.

Objective: Easy tool for newborn screening of Gaucher and Hurler diseases.

Methods: Method comparison between fluorometric enzymatic activity assay on a digital microfluidic platform and micro-titer plate bench assay was performed on normal (n = 100), Gaucher (n = 10) and Hurler (n = 7) dried blood spot samples.

Results: Enzymatic activity analysis of glucocerebrosidase (Gaucher) and α-l-iduronidase (Hurler) revealed similar discrimination between normal and affected samples on both platforms.

Enterococcus faecalis inhibits hyphal morphogenesis and virulence of Candida albicans.

The Gram-positive bacterium Enterococcus faecalis and the fungus Candida albicans are both found as commensals in many of the same niches of the human body, such as the oral cavity and gastrointestinal (GI) tract. However, both are opportunistic pathogens and have frequently been found to be coconstituents of polymicrobial infections. Despite these features in common, there has been little investigation into whether these microbes affect one another in a biologically significant manner.

A novel fluorometric enzyme analysis method for Hunter syndrome using dried blood spots.

Mucopolysaccharidosis type II (MPS II) or Hunter syndrome is a lysosomal storage disease caused by deficiency of iduronate-2-sulfatase (IDS). A convenient single-step fluorometric microplate enzyme assay has been developed and validated for clinical diagnosis of MPS II using dried blood spots (DBS). The assay compared well with a recently reported digital microfluidic method, from which it was adapted.