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•Using survey data from North Carolina, the authors described the Medicaid expansion population.•The newly eligible population had numerous unmet preventive healthcare needs.•The authors estimated 186,000 newly eligible individuals without a regular source of care.•There were also gaps in the use of wellness visits, dental care, and cancer screening.•Transitions to Medicaid can serve as an opportunity to address preventive care needs.

Establishment and maintenance of pregnancy has a substantial economic impact within the dairy industry each year. Recent research has indicated a potential role of the reproductive microbiome on impacting pregnancy status as a result of hormone concentrations and breeding strategies. However, the association between alpha (within sample metric) and beta (between samples metric) bacterial diversity with pregnancy establishment has not been extensively evaluated in dairy cattle. Thereby, the objective of this study was to analyze vaginal bacterial diversity in lactating dairy cows 1) between day of artificial insemination (AI; day 0) and maternal recognition of pregnancy (MRP; d 18), and 2) between resulting Open and Pregnant females. Lactating Holstein dairy cows (n = 53) were sampled of day of AI and day of MRP. Pregnancy determination occurred on day 32 via transrectal ultrasonography. Sterile swabs were inserted into the vagina, rotated eight times against the vaginal wall, and stored in sterile microcentrifuge tubes at -80°C. Swab samples were utilized for subsequent bacterial diversity analyses targeting the V4 hypervariable region of the 16S rRNA gene. Cows underwent transrectal ultrasonography on gestational day 32 for pregnancy determination. Sample quality was determined by FastQC before being processed with the qiime2 pipeline for taxonomic classification. Alpha diversity metrics were analyzed with Kruskal-Wallis and beta diversity was measured utilizing PERMANOVA in the qiime2 pipeline. At day 32 of gestation, the pregnancy rate was 47.2%. According to Faith’s Phylogenetic Diversity metric for alpha diversity, there was no significant difference in diversity richness (i.e., number of different bacterial species within a sample) between day of AI and MRP or between cows diagnosed as Open or Pregnant (P >0.05). Pielou’s Evenness metric (i.e., distribution or balance of bacterial species within a sample) for alpha diversity indicated greater diversity within samples at day of AI compared with day of MRP (P = 0.02). Shannon’s diversity index metric (i.e., richness and evenness within a sample) for alpha diversity also indicated greater diversity at day of AI compared with day of MRP (P = 0.04). However, there was no difference between resulting Open and Pregnant females for Pielou’s or Shannon’s metrics (P > 0.05). Distinctions between samples (beta diversity) were compared utilizing pairwise comparisons of the unweighted and weighted Unifrac distance metrics. Specifically, day of AI indicated lower diversity compared with day of MRP for both metrics (P < 0.01). However, upon comparisons of Open and Pregnant status, there was no difference between samples for unweighted or weighted Unifrac distances (P > 0.05). Based on these results, bacterial diversity within and between vaginal samples appear to shift between day of AI and day of MRP. Additional studies are needed to elucidate the mechanisms altering bacterial diversity during early gestation in lactating dairy cows.

Within the cattle industry, implementation of timed artificial insemination (TAI) or estrus detection protocols aid in determining the optimal breeding date. However, previous studies utilizing both breeding strategies have found differences between pregnancy rates, further emphasizing pregnancy establishment as a prominent issue in cattle production systems. Recent research has begun to evaluate the role of the female reproductive microbiome as it pertains to pregnancy establishment in cattle. It has been demonstrated that shifts in the female reproductive bacterial communities may alter pregnancy outcomes in cattle. Therefore, the objective of this work was to evaluate vaginal microbiomes on day of artificial insemination (AI) in dairy cattle bred utilizing either TAI or estrus detection and the impacts on subsequent pregnancy outcomes. Lactating Holstein cows (104 days in milk) were classified into two groups based on breeding protocols: 1) TAI (n = 44), and 2) Heat (n = 9). On day of AI, sterile swabs were inserted into the vagina, rotated eight times, and subsequently stored at -80°C in sterile collection tubes for microbiome analysis. For microbiome analysis, the V4 hypervariable region of the 16S rRNA bacterial gene was targeted. Statistical analysis for microbiome data were conducted using PROC TTEST in SAS where equality of variances was performed. Pregnancy rates by TAI versus Heat were 56.8% and 33.3%, respectively. The phylum Firmicuteshad greater relative abundance in cows bred by Heat (64.1 ± 2.3% vs. 53.9 ± 2.5%, respectively; P< 0.01) compared with phyla Proteobacteria(7.1 ± 0.8% vs. 13.7 ± 1.7%), Fusobacteria(0.9 ± 0.3% vs. 5.8 ± 1.5%), and Actinobacteria(1.8 ± 0.3% vs. 3.2 ± 0.5%) which had a greater relative abundance in cows bred by TAI (P <0.01). Within Firmicutes, genera Ruminococcus(13.0 ± 1.0% vs. 8.5 ± 0.6%), Blautia(10.3 ± 0.7% vs. 8.0 ± 0.5%), Clostridium(5.8 ± 0.2% vs. 4.9 ± 0.3%), Oscillospira(2.2 ± 0.2% vs. 1.7 ± 0.1%), and Caloramator(2.1 ± 0.1% vs. 1.7 ± 0.1%) were all greater in relative abundance in cows bred by Heat compared with cows bred by TAI (P <0.05). Interestingly, within Fusobacteria, genera Sneathia(0.6 ± 0.3% vs. 3.5 ± 1.0%) and Fusobacterium(0.2 ± 0.1% vs. 1.5 ± 0.5%) were greater in relative abundance in cows bred by TAI (P <0.01). Within phyla Proteobacteriaand Bacteroidetes, genera Gallibacteriumand Porphyromonasrespectively, were both greater in relative abundance in cows bred by TAI (P <0.05). Collectively these results indicate that the vaginal microbiomes of lactating dairy cows bred via TAI or estrus expression differs. Additionally, a shift in the vaginal microbiome to a prevalence of the phylum Firmicuteson day of AI appears to be negatively impacting pregnancy outcomes.

BACKGROUNDNorth Carolina remains one of several states that has not expanded Medicaid eligibility criteria to cover all low-income adults, leading to the so-called Medicaid gap, a population ineligible for Medicaid and too poor for premium subsidies through the federal Health Insurance Marketplace. Our objective was to characterize the health care access and health status of the Medicaid gap population in North Carolina.METHODSWe combined annual data from the Behavioral Risk Factor Surveillance Survey (2013-2016). Respondents who were uninsured and earning below 100% of the federal poverty guidelines (FPG) were classified as falling within the Medicaid gap and were compared to insured populations below FPG, representing the traditional Medicaid population, and to individuals above the FPG, regardless of insurance status. We reported health care access, receipt of preventive care, and current health status in unadjusted and demographically adjusted models.RESULTSCompared to either traditional Medicaid or above FPG groups, those in the Medicaid gap were 3 times as likely to have no regular source of care and twice as likely to report delaying needed care due to cost. Individuals in the Medicaid gap were more likely than individuals above FPG to report multiple chronic conditions (22% versus 16%) or a functional disability (35% versus 15%), but less likely than the traditional Medicaid population to do so.CONCLUSIONWhile less likely than the traditional Medicaid population to have complex health needs, we found that individuals in the North Carolina Medicaid gap report numerous health care access barriers and lower use of preventive care.

The goal of value-based care is simple: deliver care that improves the health of patients at the lowest possible cost. In recent years, concerns about health care value have led to the emergence of multiple value-based frameworks for decision-making. This commentary describes how the concept of value is defined for different stakeholders, discusses the impact of the value-based movement, and offers perspective on future directions for prioritization and policymaking.

Background: Population control of domestic, wild, invasive, and captive animal species is a global issue of importance to public health, animal welfare and the economy. There is pressing need for effective, safe, and inexpensive contraceptive technologies to address this problem. Contraceptive vaccines, designed to stimulate the immune system in order to block critical reproductive events and suppress fertility, may provide a solution. Filamentous bacteriophages can be used as platforms for development of such vaccines. Objective: In this review authors highlight structural and immunogenic properties of filamentous phages, and discuss applications of phage-peptide vaccines for advancement of immunocontraception technology in animals. Results: Phages can be engineered to display fusion (non-phage) peptides as coat proteins. Such modifications can be accomplished via genetic manipulation of phage DNA, or by chemical conjugation of synthetic peptides to phage surface proteins. Phage fusions with antigenic determinants induce humoral as well as cell-mediated immune responses in animals, making them attractive as vaccines. Additional advantages of the phage platform include environmental stability, low cost, and safety for immunized animals and those administering the vaccines. Conclusion: Filamentous phages are viable platforms for vaccine development that can be engineered with molecular and organismal specificity. Phage-based vaccines can be produced in abundance at low cost, are environmentally stable, and are immunogenic when administered via multiple routes. These features are essential for a contraceptive vaccine to be operationally practical in animal applications. Adaptability of the phage platform also makes it attractive for design of human immunocontraceptive agents.

Alterations in reward processes may underlie motivational and anhedonic symptoms in depression and schizophrenia. However it remains unclear whether these alterations are disorder-specific or shared, and whether they clearly relate to symptom generation or not. We studied brain responses to unexpected rewards during a simulated slot-machine game in 24 patients with depression, 21 patients with schizophrenia, and 21 healthy controls using functional magnetic resonance imaging. We investigated relationships between brain activation, task-related motivation, and questionnaire rated anhedonia. There was reduced activation in the orbitofrontal cortex, ventral striatum, inferior temporal gyrus, and occipital cortex in both depression and schizophrenia in comparison with healthy participants during receipt of unexpected reward. In the medial prefrontal cortex both patient groups showed reduced activation, with activation significantly more abnormal in schizophrenia than depression. Anterior cingulate and medial frontal cortical activation predicted task-related motivation, which in turn predicted anhedonia severity in schizophrenia. Our findings provide evidence for overlapping hypofunction in ventral striatal and orbitofrontal regions in depression and schizophrenia during unexpected reward receipt, and for a relationship between unexpected reward processing in the medial prefrontal cortex and the generation of motivational states.

People around the world are looking to marine ecosystems to provide additional benefits to society. As they consider expanding current uses and investing in new ones, new management approaches are needed that will sustain the delivery of the diverse benefits that people want and need. An ecosystem services framework provides metrics for assessing the quantity, quality, and value of benefits obtained from different portfolios of uses. Such a framework has been developed for assessments on land, and is now being developed for application to marine ecosystems. Here, we present marine Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST), a new tool to assess (i.e., map, model, and value) multiple services provided by marine ecosystems. It allows one to estimate changes in a suite of services under different management scenarios and to investigate trade-offs among the scenarios, including implications of drivers like climate. We describe key inputs and outputs of each of the component ecosystem service models and present results from an application to the West Coast of Vancouver Island, British Columbia, Canada. The results demonstrate how marine InVEST can be used to help shape the dialogue and inform decision making in a marine spatial planning context.

With the increasing number of children becoming long-term cancer survivors, it has become evident that these survivors are experiencing long-term neurocognitive deficits. Many of these deficits have been found to be the result of cancer-related therapies including intravenous and intrathecal chemotherapy and cranial radiation. These neurocognitive deficits include learning disabilities, cognitive deficits, attention disorders, and difficulties with memory. Cognitive remediation therapy uses a systematic approach to learning strategies that is aimed to equip these affected children with proper, effective, and proven learning strategies. This article will briefly discuss the neurocognitive deficits experienced by long-term childhood cancer survivors. Cognitive remediation therapy will then be introduced with specific attention to the cognitive remediation program developed by Butler and Copeland. Finally, implications for practice and future research will be discussed.

The human skin holds the full machinery for pro-opiomelanocortin processing. The α-melanocyte-stimulating hormone (α-MSH)/melanocortin-1-receptor cascade has been implicated as a major player via the cAMP signal in the control of melanogenesis. Only very recently the β-endorphin/μ-opiate receptor signal has been added to the list of regulators of melanocyte dendricity and melanin formation. In this context it was reported that (6R)-l-erythro-5,6,7,8-tetrahydrobiopterin (6BH4) can act as an allosteric inhibitor of tyrosinase, the key enzyme in melanogenesis, and this inhibition is reversible by both α- and β-MSH. It was also shown earlier that 7BH4, the isomer of 6BH4, is twice as active in this inhibition reaction. However, as yet it is not known whether 7BH4is indeed present in locoin the melanosome. We here provide evidence that this isomer is present in this organelle in a concentration range up to 50 × 10−6M. Determination of β-MSH in melanosomal extracts yielded 10 pg/mg protein. Moreover, we demonstrate reactivation of the 7BH4/tyrosinase inhibitor complex by β-MSH, whereas α-MSH failed to do so. Furthermore, we show intra-melanosomal l-dopa formation from dopachrome by 7BH4in a concentration range up to 134 × 10−6M. Based on these results, we propose a new receptor-independent mechanism in the control of tyrosinase/melanogenesis by β-MSH and the pterin 7BH4.

AbstractBetween 2001 and 2003, we undertook 137 boat surveys for White-bellied Sea-Eagles, to investigate the abundance and distribution in Jervis Bay, New South Wales, Australia. Adult sighting rates differed between years, being highest in 2003, and both adult and sub-adult Sea-Eagle numbers differed between seasons. High sighting rates of sub-adults each autumn (April) were thought to reflect not only the appearance of locally fledged juveniles but also an influx of immature birds (2–4 years old) from outside the study area. Although it was common to observe single adult birds and pairs throughout the year, influxes of sub-adults in autumn generally led to an increase in observed group size. The largest group of Sea-Eagles observed contained eight individuals and most groups larger than two contained both adults and sub-adults. Observability was related to age-class and behaviour, with perching behaviour common in adults but relatively rare for sub-adults. The density of Sea-Eagles, and sub-adults in particular, was highest on the undeveloped northern and southern headlands, which are military and conservation reserves, compared with the urban settlements on the western shore of the study area. Furthermore, Sea-Eagles were only observed perching in forest reserves interspersed between urbanised areas, despite the appearance of suitable perches throughout the coastal suburbs. In view of these results, we discuss the possible implications for management of Sea-Eagle habitat.

Between 2001 and 2003, we undertook 137 boat surveys for White-bellied Sea-Eagles, to investigate the abundance and distribution in Jervis Bay, New South Wales, Australia. Adult sighting rates differed between years, being highest in 2003, and both adult and sub-adult Sea-Eagle numbers differed between seasons. High sighting rates of sub-adults each autumn (April) were thought to reflect not only the appearance of locally fledged juveniles but also an influx of immature birds (2?4 years old) from outside the study area. Although it was common to observe single adult birds and pairs throughout the year, influxes of sub-adults in autumn generally led to an increase in observed group size. The largest group of Sea-Eagles observed contained eight individuals and most groups larger than two contained both adults and sub-adults. Observability was related to age-class and behaviour, with perching behaviour common in adults but relatively rare for sub-adults. The density of Sea-Eagles, and sub-adults in particular, was highest on the undeveloped northern and southern headlands, which are military and conservation reserves, compared with the urban settlements on the western shore of the study area. Furthermore, Sea-Eagles were only observed perching in forest reserves interspersed between urbanised areas, despite the appearance of suitable perches throughout the coastal suburbs. In view of these results, we discuss the possible implications for management of Sea-Eagle habitat.

Highlights readers' opinions on a variety of issues. What it is like to have a son with Down's syndrome who likes to hug; How a black man learned to appreciate life after being put in prison; Woman who finds a lump in her breast that is diagnosed as cancer; Person with same-sex attractions; Others.

Selective D1dopamine agonists represent a potential pharmacotherapy for the treatment of cocaine addiction. Here we report that systemic injections of the novel D1agonist ABT-431 lack the ability to induce cocaine-seeking behavior, and completely attenuate the ability of cocaine to induce this behavior in rats tested in a reinstatement paradigm. Similar doses suppress the initiation of cocaine self-administration, and produce an extinction-like response pattern in animals that subsequently initiate self-administration, without altering responding maintained by food pellets. There was no tolerance to this effect over 4 days of testing. The results suggest that ABT-431 attenuates the motivation to seek cocaine, and masks the reinforcing effects of cocaine during self-administration. The profile of ABT-431 is similar to the behavioral effects of other structurally distinct D1agonists, and is consistent with the desired profile of a "methadone-like" compound for cocaine addiction.

The article reviews the exhibition "Robert Barsamian: Paintings and Drawings" at the Conduit Gallery in Dallas, Texas from February 19-April 5, 1988.

ABSTRACTEquine protozoal myeloencephalitis (EPM) is a neurologic syndrome seen in horses from the Americas and is mainly caused by Sarcocystis neurona. Recently, a 29-kDa surface antigen from S. neuronamerozoites was identified as being highly immunodominant on a Western blot. This antigen has been sequenced and cloned, and the expressed protein has been named SnSAG1. In a previous study, cell-mediated immune responses to SnSAG1 were shown to be statistically significantly reduced in horses with EPM in comparison to EPM-negative control horses. It therefore appears as though the parasite is able to induce immunosuppression towards parasite-derived antigens as parasite-specific responses are decreased. Isolated peripheral blood lymphocytes from 21 EPM (cerebrospinal fluid [CSF] Western blot)-negative horses with no clinical signs and 21 horses with clinical signs of EPM (CSF Western blot positive) were cocultured with SnSAG1 for 48 and 72 h, and the effect on cytokine production was investigated by means of reverse transcriptase PCR. Cytokines assayed include gamma interferon (IFN-?), tumor necrosis factor alpha, interleukin (IL)-2, IL-4, and IL-6. ß-Actin was used as the housekeeping gene. A Wilcoxon signed-rank test of the findings indicated that there was a statistically significant decrease in IFN-? production after 48 h in culture for samples from horses with clinical disease. There was also a statistically significant increase in IL-4 production after 72 h in culture for samples from horses with EPM. These results further support the notion that this parasite is able to subvert the immune system in horses with clinical disease.

(Abstracted from Am J Obstet Gynecol2017;217(5):574.e1–574.e9)In the United States, heavy menstrual bleeding accounts for one-third of all gynecology visits. Multiple treatment options exist for women with symptoms that cannot be controlled with more conservative methods such as oral contraceptives.